New Jersey § 26:2ss-2

§ 26:2ss-2.

The Legislature finds and declares that: a. The health care delivery system in New Jersey needs reforms that will enhance consumer

protections, create a system to resolve certain health care billing disputes, contain

rising costs, and measure success with respect to these goals; b. Despite existing State and federal laws and regulations to protect against certain

surprise out-of-network charges, these charges continue to pose a problem for health

care consumers in New Jersey. Many consumers find themselves with surprise bills for hospital emergency room procedures

or for charges by providers that the consumer had no choice in selecting; c. While the Patient Protection and Affordable Care Act added new patient protections

requiring federally-regulated group health plans to reimburse for out-of-network emergency

service by paying the greatest of three possible amounts: (1) the amount negotiated

with in-network providers for the emergency service furnished; (2) the amount for

the emergency service calculated using the same method the plan generally uses to

determine payments for out-of-network services; or (3) the amount that would be paid

under Medicare for the emergency service, patients continue to face out-of-network

charges for surprise bills; d. Out-of-network benefits are a health insurance benefit enhancement for which insureds

pay an additional premium, but in recent years, out-of-network coverage has been used

inappropriately as a means to diminish consumers' health insurance coverage, exposing

consumers to additional costs; e. Carriers and consumers continue to report exorbitant charges by certain health

care professionals and facilities for out-of-network services, including balance billing,

and in certain cases, consumers' bills are referred to collection, which contributes

to the increasing costs of health care services and insurance and imposes hardships

on health care consumers; f. Health care providers and hospitals report that inadequate reimbursement from carriers

and government payers is causing financial stress on safety net hospitals, deteriorating

morale among providers and reduced quality of care for consumers; g. It is, therefore, in the public interest to reform the health care delivery system

in New Jersey to enhance consumer protections, create a system to resolve certain

health care billing disputes, contain rising costs, and measure success with respect

to these goals.