Section 26:2SS-8 - Coverage for inadvertent out-of-network emergency services.

NJ Rev Stat § 26:2SS-8 (2019) (N/A)

Copy with citation

Copy as parenthetical citation

26:2SS-8 Coverage for inadvertent out-of-network emergency services.

8. a. If a covered person receives inadvertent out-of-network services or medically necessary services at an in-network or out-of-network health care facility on an emergency or urgent basis as defined by the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. s.1395dd et seq. and section 14 of P.L.1992, c.160 (C.26:2H-18.64), the health care professional performing those services shall:

(1) in the case of inadvertent out-of-network services, not bill the covered person in excess of any deductible, copayment, or coinsurance amount; and

(2) in the case of emergency and urgent services, not bill the covered person in excess of any deductible, copayment, or coinsurance amount, applicable to in-network services pursuant to the covered person's health benefits plan.

b. If the carrier and the professional cannot agree on a reimbursement rate for the services provided pursuant to subsection a. of this section, pursuant to section 9 of this act the carrier, professional, or covered person, as applicable, may initiate binding arbitration pursuant to section 10 or 11 of this act.

c. This section shall only apply to providers providing services to members of entities providing or administering a self-funded health benefits plan and its plan members if the entity elects to be subject to section 9 of this act pursuant to subsection d. of that section.

L.2018, c.32, s.8.

Previous Section

Section 26:2SS-7 - Billing for emergency, urgent care.

Next Section

Section 26:2SS-9 - Responsibilities of carrier relative to inadvertent out-of-network services.