New Jersey Regulators Approve Penalties for PIP Patients Using OON Centers

The New Jersey Department of Banking and Insurance recently approved measures that will allow insurers to assess a penalty of up to 30 percent of eligible charges for Personal Injury Protection plan patients that use out-of-network ASCs.

The DOBI will also now allow insurers to waive co-payments and deductibles when PIP patients seek treatment at an in-network provider, referred to as an "organized delivery system" by the DOBI.

Additionally, the DOBI states that plan members must be notified when submitting a claim about the penalty fee and the waiving of co-payments and deductibles if their plan includes such provisions.

ASCs in the state, many of which operate on an OON basis, see the regulation as yet another challenge to their livelihood. Jeffrey Shanton, director of business management at Journal Square Surgical Center in Jersey City, N.J., further argues that there is no obvious need for the regulation and essentially "forces" ASCs in the state to join networks.

Scott Becker, JD, CPA,  notes this is another indication of the reduced ability of ASCs to rely on out-of-network status for revenues and the increased collegiality between insurers and the departments of insurance and their ability to steer patients to in network providers.

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