Out-of-Network Disclosure

Learn about your rights as a New Jersey patient, and stay informed about potential costs when using out-of-network medical services.

Protection From Unexpected Costs

On June 1, 2018, New Jersey introduced the “Out-Of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act.” This law aims to protect patients by making sure they are well-informed about the costs they might face when receiving medical services from facilities outside their insurance network. These rules apply to a broad range of healthcare facilities, including general hospitals, independent emergency departments, and both hospital-based and standalone surgical centers.

How the Disclosure Is Shared

Facilities must provide patients with a disclosure form explaining if they are part of the patient's insurance network. This needs to be done in different ways, depending on how the appointment is made:

Via Telephone: The facility will tell you about their network status over the phone and send a disclosure form for you to sign before your appointment.
In Person: When you book directly at the facility, they will give you the disclosure form and can explain it if you ask.
Electronically: If you book through an electronic system, it will show you the necessary disclosure form and record your acknowledgment.

Disclosure Overview

Under the Act, facilities are mandated to include certain information on their websites to ensure transparency and facilitate patient decision-making. This includes the following:

A list of all health benefit plans in which the facility participates
A notice clarifying that charges for physician services are not included in the facility's billing
Information on whether physicians at the facility participate in the same health benefit plans as the facility itself
An advisory for patients to verify with their physician which health plans the physician is part of to understand insurance coverage better
A recommendation for patients to contact their insurance carriers to discuss coverage details such as copayments, deductibles, and coinsurance
The contact details (name, mailing address, and phone number) for all hospital-based physician groups contracted by the facility
The contact information (name, mailing address, and phone number) for all physicians employed by the facility, including the health plans they accept

Accessibility of Pricing Information

Lastly, each facility must publicly share its standard charges in a way that aligns with federal guidelines outlined in section 2718(e) of the Public Service Health Act. This law ensures you have all the necessary information about potential costs before receiving any medical services, helping you avoid unexpected expenses.

Out-of-Network Disclosure

Protection From Unexpected Costs

How the Disclosure Is Shared

Disclosure Overview

Accessibility of Pricing Information

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