Section 2A:53A-31 - Findings, declarations relative to liability for certain health care treatment decisions

NJ Rev Stat § 2A:53A-31 (2019) (N/A)

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2A:53A-31. Findings, declarations relative to liability for certain health care treatment decisions

2. The Legislature hereby finds and declares that:

a. Health and dental carriers, in particular health maintenance organizations and other managed care entities, have become increasingly involved in health care treatment decisions, including, but not limited to, the use of financial incentives to providers and practice guidelines, in an effort to reduce health care costs;

b. As a result, many carriers have been reducing or denying medically necessary health care treatments for their insured patients;

c. Since the carriers are in many instances making medical decisions when they deny, delay, or diminish health care treatments, they should be held to the same level of legal responsibility as physicians and other health care providers who make decisions regarding the necessity and appropriateness of medical care; and

d. It is fair and appropriate that insured patients have the opportunity to dispute carrier or organized delivery system decisions in court, as well as in internal and external appeals procedures, so that these disputes may be quickly and efficiently resolved in ways that best accommodate the needs of the insured patient.

L.2001,c.187,s.2.

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Section 2A:53A-32 - Definitions relative to liability for certain health care treatment decisions