By Joshua Lerner, LCSW
Legislation was passed on 1/16/11 PL 2009, C.209, which amended the Health Care Quality Act (HCQA) (N.J.S.A. 26:2S-1). This legislation is listed as P.L. 2009, c. 209 “Assignment of Health Benefits Under Managed Care Plans” in the bulletin of the Department of Banking and Insurance. It sets out regulations which require insurance companies to directly pay “providers” when the patient has indicated their wish to assign benefits. The regulation would either require the direct payment to us or the check being made out in both patient and provider’s names. This bill was passed in part due to the lawsuit by NJPA. If the insurance companies follow the regulations this will be a real gain for all therapists who are out of network. No longer will we have to be dependent on the patient to “bring the check in” but will receive it directly from the insurance company. We already have to deal with the psychological effect of the patient not paying themselves most of the money anyway. This will only mean that the monies will come directly to us. We will still need to be aware of how this affects the transference and the valuing of the treatment. You can click on the following attachment or paste it to your address section to read the details of the letter from Commissioner Considine. http://www.state.nj.us/dobi/bulletins/blt10_36.pdf.
Early indications are that Horizon has been extremely spotty in their adhering to the policy. Some Horizon Direct Access contracts have had payments go to therapists while others to the patients. The same has been true of PPO and Traditional contracts. We will have to wait to see what the future holds and whether there will have to be further struggles to force the insurance industry to follow the regulations.