Bill > S4660

This bill eliminates the $25 application processing fee for consumers seeking an independent review of health insurance carrier decisions through the Independent Health Care Appeals Program. Currently, individuals or healthcare providers can apply to this program to challenge a carrier's decision to deny, reduce, or terminate health benefits, but they previously had to pay an application fee. The bill removes this fee requirement, making the appeals process more accessible, particularly for those who might find the fee financially burdensome. The Independent Health Care Appeals Program allows covered persons or healthcare providers to seek a medical necessity review of a carrier's final decision after exhausting the carrier's internal appeals process. Applicants must submit details about the medical condition, carrier information, and the carrier's decision, and can have a healthcare provider appeal on their behalf with the covered person's consent. The bill aligns with the Governor's fiscal year 2026 budget recommendations to remove financial barriers to appealing health insurance carrier decisions, potentially helping more consumers challenge benefit denials or reductions.

Budget and Finance

https://www.njleg.state.nj.us/bill-search/2024/S4660