Sponsored by:
Assemblyman CARMELO G. GARCIA
District 33 (Hudson)
Assemblyman REED GUSCIORA
District 15 (Hunterdon and Mercer)
Assemblyman JOHN F. MCKEON
District 27 (Essex and Morris)
Assemblywoman MARLENE CARIDE
District 36 (Bergen and Passaic)
Assemblyman JOSEPH A. LAGANA
District 38 (Bergen and Passaic)
SYNOPSIS
Prohibits hospitals from referring certain unpaid medical bills to collection agencies.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning collection of unpaid medical expenses and supplementing Title 26 of the Revised Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall not refer to a collection agency any unpaid portion of a bill that is due and payable to the facility for health care services received by a patient in any case in which:
(1) the patient was referred for a health care service by a health care professional in the course of providing inpatient care to the patient at the facility;
(2) the health care service was provided to the patient by the health care professional to whom the patient was referred; and
(3) the patient's health insurer has declined to pay all or a portion of a claim for the health care service on the grounds that the professional to whom the patient was referred is not included in the insurer's coverage network.
b. The prohibition in subsection a. of this section shall only apply to that portion of a patient's unpaid bill that is attributable to a claim for insurance coverage that is denied on the grounds that the professional who provided the care is not included in an insurer's coverage network. Any other portion of an unpaid bill that is due and payable by the patient to the health care facility may be referred to a collection agency in the ordinary course or collected using any other lawful means.
c. Nothing in this section shall be deemed to expunge any portion of an unpaid bill that is subject to the prohibition in subsection a. of this section or to prohibit a hospital from attempting to collect that unpaid portion of the bill by lawful means other than referral to a collection agency.
2. This act shall take effect on the first day of the fourth month next following enactment.
STATEMENT
This bill prohibits health care facilities from referring unpaid bills for out-of-network health care services to a collection agency when the out-of-network care was provided pursuant to a referral made through a health care professional treating the patient at the facility. This prohibition only applies to that portion of a patient's unpaid bill that is attributable to the out-of-network care provided; all other unpaid bills may be referred to a collection agency in the ordinary course or collected by other lawful means. Additionally, the bill only prohibits collection efforts made through a collection agency; it does not prohibit a health care facility from attempting to collect the balance of the unpaid bill for out-of-network care by any other lawful means.