NJ Governor Phil Murphy recently signed into law the Out-of-Network (OON) Consumer Protection, Transparency, Cost Containment and Accountability Act, which goes into effect on Wednesday, August 29, 2018.
The Act requires that consumers receive certain information from providers prior to scheduling an appointment for non-emergency or elective covered services in hospital settings, ambulatory surgical, or procedural settings about whether the provider is in network or out of network with the consumer’s health plan and about how that affects their out-of-pocket costs.
The Act also limits patients’ out-of-pocket costs when their health plan is in network with a provider and when they receive emergency or inadvertent out-of-network services and sets up a process for resolving disputes over how much carriers must pay providers for out-of-network services.
Cooper is complying with this law by:
- Providing the disclosures about accepted health plans and patients’ financial responsibilities on the website and when they make appointments.
- Notifying patients if they are in or out of network, and what financial responsibilities they have for services at the time they make an appointment.
- Providing billing estimates when requested.
- Billing in compliance with the limitations in the law.
What You Need to Know and Do
All employees should make themselves aware of the essential requirements of the law and where to send patients for more information using the following resources:
- Employee Resources
- PowerPoint presentation detailing the requirements of the OON Act and Cooper’s responsibilities
- Consumer Resources
- A current list of accepted health insurance plans on the Cooper website
- Information on our website regarding provider status, billing, and financial responsibility
Scheduling staff will receive additional information to be able to educate our patients about our in-network status and patient financial responsibilities. Offices that schedule appointments will receive business cards with a telephone number to call with questions about insurance coverage and charges that they can hand to patients.
If you have any questions about the implementation of the OON Act in your areas, please ask your VP for clarification.