Bill > A5810

This bill modifies the Independent Health Care Appeals Program in New Jersey to provide a more transparent and accessible process for patients and healthcare providers to challenge health insurance carrier decisions about medical benefits. The bill establishes a formal procedure where a covered person or healthcare provider can apply to the state department for an independent review of a carrier's decision to deny, reduce, or terminate benefits, but only after completing the carrier's internal appeals process. The application must be submitted within 60 days of the carrier's final decision and must include specific documentation such as the carrier's name, a description of the medical condition, the carrier's decision details, and consent to obtain medical records. The bill also introduces a provision allowing patients to pre-authorize healthcare providers to appeal on their behalf, with the ability to revoke consent at any time. Additionally, healthcare providers are now required to notify patients whenever they initiate an appeal of a carrier's benefit determination, ensuring patients are kept informed throughout the appeals process. The goal of these changes is to promote equity and transparency in the health insurance appeals process by giving patients and providers a clear pathway to challenge potentially inappropriate coverage decisions.

Budget and Finance

https://www.njleg.state.nj.us/bill-search/2024/A5810