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- New Jersey Pathologists Advocates for Network Adequacy
On October 13, the New Jersey Society of Pathologists (NJSP), with CAP support, urged the adoption of health plan network adequacy amendments to A 4485, which include provisions applicable to hospital and facility-based physician specialists, including pathology before the New Jersey Assembly Financial Institutions and Insurance Committee. The CAP will work closely with the physician coalition and the New Jersey Medical Society to secure network adequacy requirements for hospital and facility-based physicians.
The NJSP stated that, “If plans are not compelled to provide accurate marketing of in-network services, especially pathology and laboratory services, with specialist physicians contracted on-site to provide timely and reasonable access to enrollees, then payers are engaged in bait-and-switch marketing. These schemes harm enrollees by potentially delaying essential medical services, or by diverting their services to out-of-network physicians.”
For several years, the NJSP has worked closely with other specialties, including anesthesiology, radiology, and emergency medicine to seek enactment of a statutory mandate to compel state review of health plans for hospital and facility-based physician network adequacy comprised of the specialties. Facility-based and hospital physician network adequacy laws and regulations were enacted across the country in Washington, Virginia, Louisiana, California, and New Hampshire.
In concluding remarks, the NJSP affirmed that, “At present, the New Jersey Department of Banking and Insurance lacks the necessary statutory authority and direction to scrutinize health insurance plans for having contracts with physician specialists at in-network hospitals and facilities.”