6 I Spring 2018 www.anjc.info &A Legislative Update Legal Ease or’s UPDATE Legal Q&A S C H O By Jeffrey Randolph, Esq. ANJC Legal Counsel The New Jersey Legislature has for many years attempted to pass a law to address purported abuses by out-of-network healthcare providers. Both the New Jersey House and Senate have recently passed bills S.485 and A.2039 which address this issue, and the bills as of press time were on New Jersey Governor Phil Murphy’s desk for signature or veto. The new law is targeted at “surprise bills” patients may get when they treat at an in-net- work hospital emergency department that has out-of-network healthcare providers such as anesthesiologists or radiologists. Though hospitals are the primary target of the law, the law also will affect outpatient healthcare providers such as chiropractic physicians and require enhanced notification to patients of their and affiliated providers’ network status. The following is a brief summary of these notification requirements. The proposed law requires that health- care professionals inform patients of the healthcare plans in which the professional participates and the facilities with which the professional is affiliated, including the name, address and phone number of such facilities. If the healthcare provider or affiliated professionals are out-of-network with the patient’s health plan, in order to proceed with care, the patient must acknowledge and agree to the following: 1. The patient should be advised to inquire with each provider to deter- mine their participation status and/ or contact patient’s health plan or administrator for further consultation on costs associated with these services. 2. The patient must be notified that the amount or estimated amount the healthcare professional will bill the covered person for the services is available upon request. 3. Upon request from the patient for the service and the Current Procedural Terminology (CPT) codes associated with that service, the healthcare professional must disclose to the patient in writing the amount or estimated amount that the healthcare professional will bill the covered person for the service, and the CPT codes associated with that service, absent unforeseen medical circumstances that may arise when the healthcare service is provided. 4. The patient must acknowledge that they will have a financial respon- sibility applicable to healthcare services provided by an out-of-net- work professional in excess of their in-network copayment, deductible, or coinsurance, and that they may be responsible for any costs in excess of those allowed by their health benefits plan. 5. The patient must be advised that they should contact their health insurance plan or administrator for further consultation on those costs. Once these mandatory disclosures are made and signed off by the patient, in writing, out-of-network care may proceed. The law further imposes a duty on the healthcare provider that if between the time these disclosures are made to the patient and the time the healthcare service takes place, the network status of any of the healthcare professionals changes as it relates to the patient’s health benefits plan, the professional must notify the patient promptly. These mandatory disclosures are but a small portion of the overall proposed law but are a primary aspect that will affect chiropractic physicians. As of the date of this writing, the law has passed both the House and the Senate but has not been signed into law by the governor. Accordingly, before taking any steps to comply with this proposed law, consult with your healthcare attorney or other advisor to obtain the current status of the law. NEW DISCLOSURES Under Pending Out-of-Network Law