Under New Jersey’s patient protection law, the Department of Banking and Insurance requires insurance companies pay providers a large enough reimbursement to dissuade them from balance billing a patient who received out-of-network emergency care at their facility.
But the government has faced challenges ensuring payer organizations abide by the law.
The DOBI fined UnitedHealthcare $300,000 and ordered the payer reprocess certain claims Sept. 21 related to out-of-network billing practices. Particularly, DOBI accused the health plan of improperly balance billing patients for emergent out-of-network charges submitted in 2015 and 2016.
UnitedHealthcare officials argued patient protection laws did not explicitly set a reimbursement rate for payers to pay providers, therefore it was the payer’s right to choose appropriate rates.
Two more bills designed to target balance billing practices and increase price transparency where introduced by state legislators this year. The bills’ opponents argue it is worthless to introduce more laws the state cannot effectively enforce, according to the article.
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