A recent, little-known New Jersey government ruling has allowed your insurance company to effectively take away your out-of-network benefits as of January 1, 2017.
In 2016, the New Jersey Small Employer Health Board of the Department of Banking and Insurance (DOBI), a group comprised mostly of insurance representatives, made up a rule that allows your insurance company to limit the amount of money they reimburse your out-of-network doctor.
This reimbursement was capped at a Medicare rate, and since this reimbursement rate is low, this amount for any services rendered will likely never exceed your high out-of-network deductible.
Therefore, you, the insurance subscriber, may no longer have access to your doctors, as you would otherwise be responsible for large medical bills that less than 6 months ago your insurance would mostly cover.
Jersey Doctor Patient Alliance (NJDPA) has been working with doctors and patients across the state to help reverse this disastrous rule change. We hope you will join us in our outrage over this rule change.
There are more than 200 other New Jersey doctors who are members of the NJDPA and who have also been in contact with each of their affected patients.
With this large mobilization, we hope to reverse this unjust decision. We encourage you to file a complaint with DOBI at the link below in order to restore your previously complete benefits. Guidance for what to include in your complaint is included below.
File a complaint with the New Jersey Department of Banking and Insurance
Call Gov. Christie and tell him to reverse the Small Employer Health (SEH) Benefits Program Board’s Sept. 21, 2016 decision to repeal NJAC 11:20-24.5 and NJAC 11:21-7.13. The decision, which took effect on Jan 1, has allowed insurance carriers to limit out-of-network (OON) medical reimbursements to only 110 percent of the Medicare rate.
Gov. Christie can be reached at 609-292-6000.