New Jersey § 2a:53a-31

§ 2a:53a-31.

The Legislature hereby finds and declares that: a. Health and dental carriers, in particular health maintenance organizations and

other managed care entities, have become increasingly involved in health care treatment

decisions, including, but not limited to, the use of financial incentives to providers

and practice guidelines, in an effort to reduce health care costs; b. As a result, many carriers have been reducing or denying medically necessary health

care treatments for their insured patients; c. Since the carriers are in many instances making medical decisions when they deny,

delay, or diminish health care treatments, they should be held to the same level of

legal responsibility as physicians and other health care providers who make decisions

regarding the necessity and appropriateness of medical care; and d. It is fair and appropriate that insured patients have the opportunity to dispute

carrier or organized delivery system decisions in court, as well as in internal and

external appeals procedures, so that these disputes may be quickly and efficiently

resolved in ways that best accommodate the needs of the insured patient.