This bill amends Section 11 of P.L.1997, c.192 (C.26:2S-11) to establish the Independent Health Care Appeals Program within the department, which allows covered persons or their health care providers to contest final decisions made by insurance carriers regarding the denial, reduction, or termination of benefits. The bill specifies that the appeal process is available only after the covered person or provider has completed the carrier's internal appeals process and must be initiated within 60 days of the carrier's final decision. Additionally, it requires the submission of specific information as part of the appeal application, including the carrier's details and a description of the medical condition in question.

A significant change introduced by this bill is the elimination of the $25 application processing fee previously required for appeals, which was a barrier for some consumers. The bill also allows covered persons to authorize their health care providers to appeal on their behalf and mandates that providers notify covered persons whenever an appeal is initiated or continued. This legislation aims to promote equity in the health insurance appeal process by removing financial obstacles for consumers seeking to challenge insurance decisions.

Statutes affected:
Introduced: 26:2S-11
Advance Law: 26:2S-11