NJ Surprise Bill for OON providers - The Aftermath

[ClaimCare]

Hello Everyone.

I own a billing company and specialise in managing billing of OON, IONM providers in particular. Any one in the forum who manages OON billing has experienced poor payments from the Insurances after the passing of this bill in Sep 2018? Please share your experiences along with the insurance name.

[Michele]

I'm not in NJ but we do have a few providers who are out of network with certain plans.  This bill has actually helped them in that if they have a patient they see in the hospital who happens to have a plan they are not in network with then we can send them a surprise bill and then the provider is paid.  So for us it has been a plus. 

[ClaimCare]

Yes. definitely it always helps for an OON provider as the reimbursements rates are always high compared to fixed rates for IN providers, however for certain commercial insurances like CIGNA,AETNA and especially Horizon, payments have went down compared to what they were paying to our clients earlier before the bill was put in place.
Arbitration however is the second best option to opt for.

[PMRNC]

I've got clients in NJ I do consulting and credentialing for. We've not experienced any "loss" due to this. Of course if you are out of network you probably will see a revenue loss but it would be the result of non-contract/non assignment clauses. I don't see any of these states overturning these surprise medical bill rulings as a biller or as a consumer.