Bill > A5793

This bill prohibits health insurance carriers from denying payment on all or a portion of a claim while seeking coordination of benefits (COB) information, regardless of whether the carrier believes good cause exists to think other insurance is available. Specifically, the bill removes previous language that defined "good cause" for delaying payment, which previously required the carrier's records to indicate other coverage exists and stated that routine COB requests would not constitute good cause. Under the new provisions, carriers cannot withhold or deny payment simply because they are attempting to determine if a patient has additional insurance coverage. The bill applies to various types of health insurance entities including hospital service corporations, medical service corporations, health service corporations, health insurers, and health maintenance organizations. The changes will take effect 90 days after enactment and will apply to insurance plans, contracts, or policies entered into or renewed after that date. The goal appears to be preventing insurance carriers from delaying legitimate claim payments while conducting routine benefit coordination investigations.

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https://www.njleg.state.nj.us/bill-search/2024/A5793