New Jersey § 26:2ss-5

§ 26:2ss-5.

a. Except as provided in subsection f. of this section, a health care professional

shall disclose to a covered person in writing or through an internet website the health

benefits plans in which the health care professional is a participating provider and

the facilities with which the health care professional is affiliated prior to the

provision of non-emergency services, and verbally or in writing, at the time of an

appointment. If a health care professional does not participate in the network of the covered

person's health benefits plan, the health care professional shall, in terms the covered

person typically understands: (1) Prior to scheduling a non-emergency procedure inform the covered person that the

professional is out-of-network and that the amount or estimated amount the health

care professional will bill the covered person for the services is available upon

request; (2) Upon receipt of a request from a covered person for the service and the Current

Procedural Terminology (CPT) codes associated with that service, disclose to the covered

person in writing the amount or estimated amount that the health care professional

will bill the covered person for the service, and the CPT codes associated with that

service, absent unforeseen medical circumstances that may arise when the health care

service is provided; (3) Inform the covered person that the covered person will have a financial responsibility

applicable to health care services provided by an out-of-network professional, in

excess of the covered person's copayment, deductible, or coinsurance, and the covered

person may be responsible for any costs in excess of those allowed by their health

benefits plan; and (4) Advise the covered person to contact the covered person's carrier for further

consultation on those costs. b. A health care professional who is a physician shall provide the covered person,

to the extent the information is available, with the name, practice name, mailing

address, and telephone number of any health care provider scheduled to perform anesthesiology,

laboratory, pathology, radiology, or assistant surgeon services in connection with

care to be provided in the physician's office for the covered person or coordinated

or referred by the physician for the covered person at the time of referral to, or

coordination of, services with that provider. The physician shall provide instructions as to how to determine the health benefits

plans in which the health care provider participates and recommend that the covered

person should contact the covered person's carrier for further consultation on costs

associated with these services. c. A physician shall, for a covered person's scheduled facility admission or scheduled

outpatient facility services, provide the covered person and the facility with the

name, practice name, mailing address, and telephone number of any other physician

whose services will be arranged by the physician and are scheduled at the time of

the pre-admission, testing, registration, or admission at the time the non-emergency

services are scheduled, and information as to how to determine the health benefits

plans in which the physician participates, and recommend that the covered person should

contact the covered person's carrier for further consultation on costs associated

with these services. d. The receipt or acknowledgement by any covered person of any disclosure required

pursuant to this section shall not waive or otherwise affect any protection under

existing statutes or regulations regarding in-network health benefits plan coverage

available to the covered person or created under this act. e. If, between the time the notice required pursuant to subsection a. of this section

is provided to the covered person and the time the procedure takes place, the network

status of the professional changes as it relates to the covered person's health benefits

plan, the professional shall notify the covered person promptly. f. In the case of a primary care physician or internist performing an unscheduled

procedure in that provider's office, the notice required pursuant this section may

be made verbally at the time of the service. g. The appropriate professional or occupational licensing board within the Division

of Consumer Affairs in the Department of Law and Public Safety shall specify in further

detail the content and design of the disclosure form and the manner in which the form

shall be provided.