Bill Text: NJ A2128 | 2020-2021 | Regular Session | Introduced
Bill Title: Prohibits health insurance carriers from denying payment for preauthorized covered services except under certain circumstances.
Spectrum: Partisan Bill (Democrat 3-0)
Status: (Introduced - Dead) 2020-01-14 - Introduced, Referred to Assembly Financial Institutions and Insurance Committee [A2128 Detail]
Download: New_Jersey-2020-A2128-Introduced.html
STATE OF NEW JERSEY
219th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2020 SESSION
Sponsored by:
Assemblyman P. CHRISTOPHER TULLY
District 38 (Bergen and Passaic)
Assemblywoman LISA SWAIN
District 38 (Bergen and Passaic)
Assemblywoman VALERIE VAINIERI HUTTLE
District 37 (Bergen)
SYNOPSIS
Prohibits health insurance carriers from denying payment for preauthorized covered services except under certain circumstances.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning preauthorized covered services under certain health benefits plans and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any law or regulation to the contrary, a carrier shall not use utilization management review for medical necessity to deny payment of a claim to a covered person for a covered service under a health benefits plan if the carrier provided prior authorization for that service, except in situations in which:
a. the covered service was never provided;
b. the claim for the covered service was not timely submitted in accordance with the terms of the plan; or
c. the covered person or health care provider engaged in fraud or material misrepresentation regarding the claim for the covered service.
2. This act shall take effect immediately.
STATEMENT
This bill supplements the "Health Care Quality Act" by providing that, notwithstanding any law or regulation to the contrary, a health insurance carrier shall not use utilization management review for medical necessity to deny payment of a claim to a covered person for a covered service under a health benefits plan if the carrier provided prior authorization for that service, except in situations in which:
(1) the covered service was never provided;
(2) the claim for the covered service was not timely submitted in accordance with the terms of the plan; or
(3) the covered person or health care provider engaged in fraud or material misrepresentation regarding the claim for the covered service.
