Bill > A4975

Introduced Session

This bill prohibits health insurers, third party administrators, pharmacy benefits managers, and the State Health Benefits Program and the School Employees' Health Benefits Program from requiring the pre-approval or precertification of medical tests, procedures or prescription drugs covered under a health benefits or prescription drug benefits plan. This bill will ensure that patients who are ill are not burdened with technical requirements by health benefits providers which employ utilization management review systems that slow down medical care. The sponsor is concerned that complaints from people who need medical treatment are on the rise, and feels that it is time to end the nightmare of the insurance company bureaucracy that is frustrating patients who need care and medicine. The so-called "pre-approval" process, now required by insurance companies, is a nightmare for patients across New Jersey. Historically, doctors would order a test or medicine and patients received it. Now, a myriad of bureaucratic obstacles makes patients and doctors pawns in a sad game of insurance-company chess. There are examples of cancer patients waiting for long periods of time to receive medicine because of a cumbersome and slow approval policy. The sponsor is convinced that it is time for the doctors to make decisions, not insurance companies; it is time for patients who are ill to not be burdened with technical requirements by insurance companies that employ systems that slow down medical care and are incredibly frustrating. It is the sponsor's goal that insurance companies pay for what the doctor orders.

AI Summary

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Kimberly Eulner (R)*,  Marilyn Piperno (R)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 12/12/2022)

Official Document