Assemblyman Troy Singleton (D-Mount Laurel) is circulating a bill that would have wide-ranging effects on businesses if adopted.
The draft measure would establish new regulations for reimbursements by insurance companies and other carriers offering managed-care plans to out-of -network doctors for services provided to patients within in-network facilities.
It would limit the amount charged by these doctors to insurers to 100 percent and 500 percent of the Medicare rate.
If attempts to negotiate reimbursement for the out-of -network services don't result in a resolution within 14 days of the carrier being billed, the insurance carrier or the provider could initiate binding arbitration. A written decision by the arbitrator would be required within 30 days of the request being made to the Department of Banking and Insurance.
Beneficiaries who receive care from an out-of -network provider in an in-network facility wouldn't have to pay more than they would have for an in-network provider, under the draft proposal. This wouldn't apply to those who don't comply with preauthorization or medical necessity review requirements, or those who choose out-of -network providers when there is an in-network doctor who provides the service.