www.njchiropractors.com I 9 •  Clear and understandable description of the plan’s out-of-network health care benefits, including the method- ology used by the entity to determine the allowed amount for out-of-net- work services; •  The allowed amount the plan will reimburse under that methodology and, in situations in which a covered person requests allowed amounts associated with a specific Current Procedural Terminology code, the portion of the allowed amount the plan will reimburse and the portion of the allowed amount that the covered person will pay, including an explanation that the covered person will be required to pay the difference between the allowed amount as defined by the carrier’s plan and the charges billed by an out-of-network provider; •  Examples of anticipated out-of-pocket costs for frequently billed out-of-net- work services; •  Information in writing and through an internet website that reasonably permits a covered person or prospec- tive covered person to calculate the anticipated out-of-pocket cost for out-of-network services in a geographical region or zip code based upon the difference between the amount the carrier will reimburse for out-of-network services and the usual and customary cost of out-of-network services; •  Information in response to a covered person’s request, concerning whether a healthcare provider is an in-network provider; •  Such other information as the commis- sioner determines appropriate and necessary to ensure that a covered person receives sufficient information necessary to estimate their out-of- pocket cost for an out-of-network service and make a well-informed healthcare decision; and •  Access to a telephone hotline that shall be operated no less than 16 hours per day for consumers to call with questions about network status and out-of-pocket costs. Should a patient receive medically necessary emergency services at an out-of-network healthcare facility or inadvertently receive care that is covered by insurance but from an out-of-network professional, whether at an in-network or out-of-network health care facility, the legislation stipulates that the patient may incur no greater out-of-pocket costs than they would have incurred with an in-network provider for services that are covered. The most controversial part of the legislation is the arbitration process. The legislation outlines a process of binding arbitration to be initiated for certain emergency and out-of-network billing situations in the event that a carrier and healthcare provider cannot agree on a reimbursement rate. In addition, as it relates to self-funded health plans that do not elect to be subject to arbitration under the bill, the bill provides for arbitration between the self-funded plan member and the out-of-network provider if attempts to negotiate reimbursement for services do not result in a resolution of the payment dispute. If attempts to negotiate reimbursement for services provided by an out-of-net- work healthcare provider do not result in a resolution, the carrier, or self-funded plan that opts in, or out-of-network health care provider may initiate binding arbitration to determine payment for the services if the difference between the carrier’s or self-funded plan’s final offer and the provider’s final offer is not less than $1,000. The legislation also outlines parameters for carrier and provider arbitration time- lines and carriers’ final payments, and requires that they report claim denials and down coding to the Department of Banking and Insurance. In additional, it mandates DOBI to issue a report to the governor and legislature on the bill’s impact on annual savings to both policyholders and the state healthcare system. Governor Murphy has 45 days to sign the legislation. Jon Bombardieri and his firm, CLB Partners, serve as the Government Affairs Counsel to the ANJC. ANJC needs our members to donate to the ANJC Political Action Committee (PAC) as we continually have to fight to protect and advance our patients and profession in the political arena. Your small monthly donation to ANJC PAC will help grow our political strength by supporting legislators and policymakers who make the decisions that impact your practice and our profession. Without a voice in Trenton and beyond, we would be doomed to gradually worsening conditions to practice and earn a living, with no say in the decisions. We need your help… Now! ANJC PAC is fighting for: •  Greater patient access to chiropractic care •  Lawsuits against major carriers who improperly deny care •  Improved public relations •  Veteran’s benefits to access chiropractic care •  Opening Worker’s Compensa- tion for chiropractic care •  Stopping improper denials of your care by payers •  and much more! We Need YOU to Donate a Small Amount to Make a Big Difference! ANJC PAC has set a goal for each New Jersey Chiropractor to donate only $25/month to the PAC to help build our funds as never before. You can donate online at www.anjc.info by clicking Legislation, then PAC. If everyone gives a little, we can make a big difference together! TM