Blog

Today, Kaiser Health News published an insightful article on the Federal Surprise Bills being considered.  Federal legislation is likely to significantly expand patient protection, in states that already have surprise bills enacted, by including self-funded plans under ERISA and will provide much needed protection in states where surprise bills have yet to be enacted.  Details […]

On January 22, 2019 the NJ Bill S-3203, sponsored by Senator Joseph Lagana and Senator Vin Gopal, requiring hospitals to provide breast cancer patients with information concerning reconstructive surgery was released from committee and will head to the full Senate for further consideration.  Additionally, the legislation will not limit a health care provider in making […]

As part of the agreement, EmblemHealth will provide full restitution to members who paid out-of-pocket for gender reassignment surgical procedures after denial of coverage by EmblemHealth.  For the full article please click here.

Law360 (December 11, 2018, 10:09 PM EST) has published an article covering another case in which Cohen Howard has successfully challenged the under-reimbursement of authorized medical services rendered by our client, an out-of-network provider.  For the full article please click Law 360 Article on Linares Decision. For the complete Opinion issued by Chief District Judge […]

On November 20, 2018, The New Jersey Department of Banking and Insurance (“DOBI”) released Bulletin No. 18-14 (the “Bulletin”) relating to Implementation of P.L. 2018 C. 32 (N.J.S.A. 26:2SS-1 to -20) Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Surprise Bill Act”).  As a reminder, the Surprise Bill Law relates to ER and […]

Out-Of-Network Health Care Provider Isn’t Seeking ERISA Benefits, Judge Says (Lexis Legal News) TRENTON, N.J. — An out-of-network provider is not a beneficiary of an Employee Retirement Income Security Act plan (ERISA), and because the plan includes an anti-assignment provision, it cannot sue to recover benefits under the law, a federal judge in New Jersey […]

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) […]

In order to facilitate proper claim reimbursements and to file health benefit claims on behalf of your patients, your Assignment of Benefits and Designated Authorized Representative Form(s) must be updated to include a Limited Special Power of Attorney based on the court decision below. We have prepared this document for our clients and can do […]

The conference room of the APA Hotel in Woodbridge was filled to capacity Monday, June 11, for the New Jersey Doctor-Patient Alliance Practice Enhancement Seminar focusing on what independent providers should do to prepare for the uncertainty coming with the new out-of-network law. Gov. Phil Murphy signed A2039/S485 into law on June 1. Before the […]

On Monday, June 11, Leslie Howard shared her insights on the NJ Surprise Bill at the NJ Doctor-Patient Alliance (NJDPA) Meeting to a packed audience of 250 healthcare providers and professionals. She provided a comprehensive roadmap of the bill’s impact highlighting the types of commercial plans and services that will be subject to the bill. […]