New Jersey § 26:2s-6

§ 26:2s-6.

a. With respect to a carrier which offers a managed care plan that provides for both

in-network and out-of-network benefits, in the event that: (1) a covered person is admitted by an out-of-network health care provider to an in-network

health care facility for covered, medically necessary health care services ; or (2) the covered person receives covered, medically necessary health care services

from an out-of-network health care provider while the covered person is a patient

at an in-network health care facility and was admitted to the health care facility

by an in-network provider, the carrier shall reimburse the health care facility for

the services provided by the facility at the carrier's full contracted rate without

any penalty for the patient's selection of an out-of-network provider, in accordance

with the in-network policies and in-network copayment, coinsurance or deductible requirements

of the managed care plan. b. The provisions of subsection a. of this section shall apply only if the covered person complies with the preauthorization

or review requirements of the health benefits plan regarding the determination of

medical necessity to access in-network inpatient benefits, as set forth in writing

pursuant to section 5 of P.L.1997, c. 192 ( C.26:2S-5 ). c. With respect to a carrier which offers a managed care plan that provides for both

in-network and out-of-network benefits, in the event that the covered person assigns,

through an assignment of benefits, his right to receive reimbursement for medically

necessary health care services to an out-of-network health care provider, the carrier

shall remit payment for the reimbursement directly to the health care provider in

the form of a check payable to the health care provider, or in the alternative, to

the health care provider and the covered person as joint payees, with a signature

line for each of the payees. Payment shall be made in accordance with the provisions of this section and P.L.1999, c. 154 ( C.17B:30-23 et al.). Any payment made only to the covered person rather than the health care provider

under these circumstances shall be considered unpaid, and unless remitted to the health

care provider within the time frames established by P.L.1999, c. 154 ( C.17B:30-23 et al.), shall be considered overdue and subject to an interest charge as provided

in that act.