State of New Jersey: Out-of-Network Consumer Protection Transparency, Cost Containment and Accountability Act, P.L. 2018
According to the Out-of-Network mandate signed by Governor Phil Murphy in 2018, protections are afforded to all patients with regards to surprise hospital billing in the state of New Jersey. Cooper University Health Care will not bill patients more than the patient’s in-network cost share for emergency/inadvertent out-of-network services.
Out-of-Network Balance Billing Protection
Health care providers are prohibited from balance billing a covered person for inadvertent out-of-network services and/or out-of-network services provided on an emergency or urgent basis above the amount of the covered person’s liability for in-network cost-sharing (i.e., the covered person’s network-level deductible, copayments, or coinsurance).
- “Inadvertent out-of-network services” means health care services that are: covered under a health benefits plan that provides a network; and are provided by an out-of-network health care provider in an in-network health care facility when in-network health care services are unavailable in that facility or are not made available to the covered person."Inadvertent out-of-network services" also include laboratory testing ordered by an in-network health care provider and performed by an out-of-network bio-analytical laboratory; and
- “Emergency or Urgent basis” means all emergency and urgent care services.
Any attempts by the out-of-network health care provider to bill the covered person for these types of services above the covered person’s in-network cost-sharing liability should be reported to the covered person’s carrier, and a complaint may be filed with the appropriate provider’s licensing board or other regulatory body, as appropriate. A complaint may also be filed with the State of New Jersey Department of Banking and Insurance. The Department will investigate the complaint and when appropriate, refer the matter to the appropriate licensing agency or regulatory body for review.
If you feel that your rights under the Out-Of-Network New Jersey State Law have been violated, please reach out to the below federal/state authorities:
New Jersey Department of Health
Division of Health Facility and Field Operations
PO Box 367
Trenton NJ 08625-0367