Acting New Jersey Gov. Stephen M. Sweeney recently signed into law a bill that would require health insurance carriers in the state to honor a patient's assignment of benefits to his or her healthcare provider, according to the Medical Society of New Jersey. The bill is scheduled to go into effect in 2011.
Under the law, the insurer may opt to issue a check jointly payable to the healthcare provider and patient; however, the check must physically be sent to the provider of services.
The law is the result of two years of advocacy by healthcare provides in response to practices in the state by insurers to send payment for out-of-network services directly to the patient rather than the healthcare provider, making it more difficult for healthcare providers to receive payment for out-of-network services.
While many healthcare providers hail the passing of the bill a victory, others contend it does not go far enough.
"The bill provides for (at the carrier's discretion) payment to the healthcare provider and the covered person, as joint payees, with a signature line for each of the payees," says Jeffrey Shanton, director of business management at Journal Square Surgical Center in Jersey City, N.J. "So, while the provider will actually get the check, it is a useless piece of paper until the patient signs."
Mr. Shanton contends that such an arrangement will not make reimbursement any easier for out-of-network ASCs and actually could make it more difficult. "Do we now mail the check to the patient, and hope they sign it and send it back? Do we physically go to the patient's residence with check in hand asking them to sign? What if the patient refused to sign? There is no provision for that, anywhere," he says.
Read the MSNJ's report on the New Jersey assignment of benefits law
.