This bill amends Section 11 of P.L.1997, c.192 to promote equity in the health insurance appeal process by eliminating the application processing fee for individuals appealing decisions made by health insurance carriers. Previously, covered persons were required to pay a $25 fee to the department for processing their appeal, although this fee could be reduced or waived in cases of financial hardship. The bill removes this fee requirement entirely, making it easier for individuals and healthcare providers to contest denials, reductions, or terminations of benefits without the burden of additional costs.

Additionally, the bill establishes that a covered person or their designated representative can authorize a healthcare provider to appeal a carrier's decision on their behalf, with the consent remaining valid throughout all stages of the appeals process. Healthcare providers are also mandated to notify covered persons whenever they initiate an appeal and provide updates as the appeal progresses. This legislation aims to enhance access to the appeals process and ensure that individuals can effectively challenge unfavorable decisions made by their health insurance carriers.

Statutes affected:
Introduced: 26:2S-11