On August 27, 2018, the Department of Banking and Insurance issued a “Synopsis of the Implementation of the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” (the “Synopsis”). The Synopsis is intended to provide guidance and clarity with regard to implementing the new regulations.
As a reminder, the law generally only applies to (i) fully-insured plans, State Health Benefit Plans and those self-funded plans that opt into the law, and (ii) services under those plans that relate to emergency care, urgent care (required care within 24 hours as being proposed by DOBI as part of the Synopsis) or inadvertent out-of-network services.
At Cohen & Howard, we continue to advise our clients on how to comply with the new proposed provisions. In particular, requirements related to disclosure, processing time frames and the new arbitration process are in the forefront. As always, we are committed to servicing the out-of-network provider community and can be reached at 732-747-5202 for any questions related to the bill or if you need any assistance with the handling of your appeals/claims.
To see the Synopsis in its entirety, please click here.