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NJ Out-of-Network Consumer Protection Act

NJ Out-of-Network Consumer Protection Act 2018-08-29T15:28:30+00:00

New Jersey Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act

CentraState is dedicated to providing consumers with as much information as possible regarding potential healthcare costs. This law has been passed to reform healthcare insurance by enhancing consumer protections against certain surprise out-of-network bills. The law also aims to create a system to resolve certain healthcare billing disputes, contain rising costs, and measure success with respect to these goals. Accordingly, we have listed information on the insurers and products the hospital participates in as well as any exceptions.

This list may not be comprehensive. For example, specialty insurers such as workers’ compensation and personal injury protection (“PIP”) are not included because there are a number of different types of insurance products and we may not participate in all of them. If you do not see your plan listed on our website, we strongly recommend that you contact us or your health insurance plan to confirm whether your plan is in-network or out-of-network.

Plans we participate in

Click here to see a list of the insurance plans that CentraState Medical Center participates in.  It is also important that you contact your insurance company prior to receiving services or care at CentraState. Each plan is different and some provide different levels of coverage that could make a difference in your out-of-pocket costs. It is always best to contact your insurance company to obtain more information.

In addition, the physicians who provide care within our hospital might not participate in the same insurance plans as the hospital. You should check with the physician who is arranging your healthcare services to see which insurance plans the physician participates in. You should also know that these healthcare professional(s)’ costs are not included in the facility’s charges. They will bill separately.

Physicians and Physicians Groups We Employ

Click here to see a list of the physicians or physician groups that are employed by CentraState Medical Center*. While the physicians are hospital employees, you may still receive a separate bill for their services in the event they process their own billing.

*Please note that information reported by the above groups may be subject to change. Healthcare providers are required to promptly update any changes to their contact information and/or insurance participation. Please visit www.centrastate.com/billing-insurance/ before your appointment for the most up-to-date information.

*NJ hospitals are currently pending regulatory guidance from the Department of Banking and Insurance (DOBI) regarding its specific definition of “employed” and “contracting”. Upon DOBI’s issuance of guidance, this information may be updated or reorganized in order to reflect the legislature’s intent.

Physicians and Physicians Groups With Whom We Contract

Click here to see a list of the physicians and physician groups that are contracted by CentraState Medical Center*.  They are not hospital employees but instead have a contract with the hospital to provide certain healthcare services. You should also know that these healthcare professionals’ costs are never included in the facility’s charges. They will bill you separately.

*Please note that information reported by the above groups may be subject to change. Healthcare providers are required to promptly update any changes to their contact information and/or insurance participation. Please visit www.centrastate.com/billing-insurance/ before your appointment for the most up-to-date information.

*NJ hospitals are currently pending regulatory guidance from the Department of Banking and Insurance (DOBI) regarding its specific definition of “employed” and “contracting”. Upon DOBI’s issuance of guidance, this information may be updated or reorganized in order to reflect the legislature’s intent.

OON Law FAQs

How do I know if this law impacts my health insurance?

The law applies to health plans issued through the NJ State Health Benefits Program and State Education Health Benefit Plan.

This law also applies to some commercial health insurance plans issued in the State of New Jersey.

Commercial health insurance plans can be funded by your employer in either one of two ways: the plan can either be fully insured or self-funded. All fully insured plans are impacted by this law. Self-funded plans may or may not be impacted as the plans may opt-in or not

How do I know if my health insurance is fully insured or self-funded?

Unfortunately, neither the hospital nor your provider is able to currently provide you with this information. Please check the back of your health insurance card. It may indicate which way your plan is funded. If you are still unsure, please either call the number for benefits on the back of your insurance card and ask how your plan is funded or call your employer’s benefits or HR department.

What health insurance plans does this law not apply to?

  • Self-funded plans governed by ERISA that have not opted-in
  • Traditional Medicare
  • Traditional Medicaid
  • Medicaid Advantage
  • Medicare Advantage Plans
  • Tricare
  • Worker’s compensation
  • Auto medical insurance
  • Personal injury protection
  • Dental insurance
  • Long-term care plans
  • Accident only plans

How does this law impact the amount I am being billed?

This law impacts patient responsibility (co-insurance, co-pay, deductible) for the following two scenarios (please remember hospitals and physicians bill separately):

  • Emergency services: For emergencies, your patient responsibility will not be more than what you would have paid at an in-network hospital. This applies to both the hospital bill and the physician(s) that treated you.
  • Non-emergency services: Unless when you scheduled your service, you “knowingly, voluntarily, and specifically” selected an out-of-network doctor or hospital. Your patient responsibility (co-insurance, co-pay and deductible) will be limited to that of an in-network doctor or hospital.  This applies to both the hospital’s bill and the healthcare professional that treats you. This law does not apply to non-covered services.

How do I know which insurance plans the hospital participates in?

To find out about the insurances the hospital participates in, visit our Billing and Insurance page.

To see which plans the hospital participates in that are governed by the NJ Out-of-Network law, click here.

If you have any questions about participation, please call 732-294-7055.

How do I know which insurance plans the healthcare professional participates in?

The healthcare professional providing the service will disclose the plans they participate in prior to the provision of services in writing or through an internet website and at the time of the appointment.

CentraState has provided a listing of the contact information for all groups and individuals that are employed or contracted by us to provide healthcare services.

Inquire if your healthcare provider participates in your plan by reaching out directly to your health plan, under this law all applicable plans will have dedicated numbers for their members to call regarding insurance coverage and provider participation.

For a scheduled admission or scheduled outpatient facility services, how do I know which physicians will see me to perform services such as anesthesiology, laboratory, pathology, or radiology?

The healthcare professional prior to providing the service will provide you with the practice name, mailing address and telephone number of any other physician reasonably expected to see you. They will also provide you information on how to determine which plans they participate in. It is advised that you contact your plan for consultation on costs.

How can I request a copy of the hospital charge master?

To obtain a copy of the hospital charge master, please call 732-294-7065.

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