Bill Text: NJ S3852 | 2018-2019 | Regular Session | Introduced

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Bill Title: Prohibits health insurance carriers from denying payment for preauthorized covered services except under certain circumstances.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2019-06-03 - Introduced in the Senate, Referred to Senate Commerce Committee [S3852 Detail]

Download: New_Jersey-2018-S3852-Introduced.html

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SENATE, No. 3852

STATE OF NEW JERSEY

218th LEGISLATURE

 

INTRODUCED JUNE 3, 2019

 

 

Sponsored by:

Senator  JOSEPH P. CRYAN

District 20 (Union)

 

 

 

 

SYNOPSIS

     Prohibits health insurance carriers from denying payment for preauthorized covered services except under certain circumstances.

 

CURRENT VERSION OF TEXT

     As introduced.

  

An Act concerning preauthorized covered services under certain health benefits plans and supplementing P.L.1997, c.192 (C.26:2S-1 et al.).

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    Notwithstanding any law or regulation to the contrary, a carrier shall not use utilization management review for medical necessity to deny payment of a claim to a covered person for a covered service under a health benefits plan if the carrier provided prior authorization for that service, except in situations in which:

     a.     the covered service was never provided;

     b.    the claim for the covered service was not timely submitted in accordance with the terms of the plan; or

     c.     the covered person or health care provider engaged in fraud or material misrepresentation regarding the claim for the covered service.

 

     2.    This act shall take effect immediately.

 

 

STATEMENT

 

     This bill supplements the "Health Care Quality Act" by providing that, notwithstanding any law or regulation to the contrary, a health insurance carrier shall not use utilization management review for medical necessity to deny payment of a claim to a covered person for a covered service under a health benefits plan if the carrier provided prior authorization for that service, except in situations in which:

     (1)   the covered service was never provided;

     (2)   the claim for the covered service was not timely submitted in accordance with the terms of the plan; or

     (3)   the covered person or health care provider engaged in fraud or material misrepresentation regarding the claim for the covered service.