MSNJ Weighs-in on PIP, EOBs, In-plan Exceptions & IURO Rules

    By: Melinda Martinson, Esq. on Nov 09, 2017

    PIP: MSNJ filed comments on a pre-proposed rule that would link certain PIP fees to Medicare. We have long advocated against the use of Medicare to set fees. This is particularly true for PIP since the statute sets the standard at 75% of reasonable and prevailing fees in the region. 

    EOBs: MSNJ has long urged the Department of Banking & Insurance (DOBI) to propose rules that would require more accuracy, transparency and accountability in patient EOBs. Carriers often misrepresent the patient's responsibility under out of network plans. We are heartened that DOBI proposed rules to help patients better understand their plan benefits, but disappointed that the proposal does not require a statement explaining the consumer protection afforded in by the hold harmless rules. We will continue to advocate for more transparency on out of network benefits. Read our comments.

    In-Plan Exceptions: MSNJ supports DOBI's rule requiring carriers to be more forthcoming in their obligation to provide out of network physicians when the network does not have a physician who is "qualified, accessible and available." We noted that this would not be a problem if networks were robust.  And we asked that out of network physicians providing service under an in-plan exception be promptly paid at the negotiated fee. Read our comments.

    IURO:  MSNJ supports DOBI's rule requiring carriers to promptly implement Independent Utilization Review Organization determinations. We agree with the requirement that denial reasons should be specific to the claim, not a list of possible reasons. We appreciate that DOBI included remittance advice (RA) forms to assist in the crosswalk between EOBs and RAs. Read our comments.

    Released: November 9, 2017, 2:08 pm | Updated: November 9, 2017, 2:09 pm
    Keywords: Announcements

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