Bill Text: NJ A2935 | 2016-2017 | Regular Session | Introduced
Bill Title: Requires in-network hospitals to notify patients of out-of-network health care professionals who provide services in hospital.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2016-02-16 - Introduced, Referred to Assembly Health and Senior Services Committee [A2935 Detail]
Download: New_Jersey-2016-A2935-Introduced.html
Sponsored by:
Assemblyman REED GUSCIORA
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires in-network hospitals to notify patients of out-of-network health care professionals who provide services in hospital.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning the provision of health care services in hospitals by out-of-network providers 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 hospital licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et al.) that is a participating provider under a patient's health insurance plan shall notify the patient or patient's representative, in writing, as soon as practicable, if physicians or other health care professionals who are under contract to, or have another arrangement with, the hospital to provide health care services to patients at the facility are not participating providers under the patient's health insurance plan.
The notification, which shall be signed by the patient or patient's representative and included in the patient's medical record, shall provide the names of the health care professionals from whom the patient is most likely to receive services at the hospital, the type or category of health care services they provide at the hospital, and the unit or department of the hospital in or through which they provide services.
2. This act shall take effect on the first day of the third month next following the date of enactment.
STATEMENT
This bill requires a hospital, which is a participating provider under a patient's health insurance plan, to notify a patient or the patient's representative, in writing, as soon as practicable, if physicians or other health care professionals who are under contract to, or have another arrangement with, the hospital to provide health care services to patients at the facility are not participating providers under that patient's health insurance plan. The notification, which is to be signed by the patient or the patient's representative and included in the patient's medical record, is to provide the names of the health care professionals from whom the patient is most likely to receive services at the hospital, the type or category of health care services they provide at the hospital, and the unit or department of the hospital in or through which they provide services.
Increasingly, insured patients who seek care at a hospital that is in the provider network of their health insurance plan receive health care services at the hospital, such as emergency room care, radiology, and anesthesia, by physicians who are not participating providers in that patient's health insurance plan. The patients usually are made aware of this situation and the fact that they may be liable for unanticipated balance billing by the physician after they have received the services. The purpose of this bill, therefore, is to provide patients with information, in advance of receiving services whenever practicable, about the insurance participation of health care professionals who will render services at the hospital, so as to enable patients to make informed decisions about the providers who treat them.
