New Jersey Assembly Bill A4975

New Jersey 2022-2023 Regular Session

• Introduced: 12/12/22
• Refer: 12/12/22

Caption

Prohibits pre-approval or precertification of medical tests, procedures and prescription drugs covered under health benefits or prescription drug benefits plans.

Impact

If passed, the bill would significantly alter how health insurers, third-party administrators, and pharmacy benefits managers operate regarding the coverage of prescribed medical tests and medications. It specifically prohibits these entities from conditioning the payment of benefits on any pre-approval or precertification, thereby granting physicians more autonomy in determining necessary care for their patients. This shift aims to streamline the healthcare process so that patients can receive the medical attention they require without unnecessary delays related to insurer protocols.

Summary

Assembly Bill A4975 aims to eliminate the requirement for pre-approval or precertification of medical tests, procedures, and prescription drugs that are covered under health benefit plans in New Jersey. This legislation is sponsored by Assemblywomen Marilyn Piperno and Kim Eulner in response to increasing complaints from patients who face delays due to the bureaucratic processes established by health insurance companies. The sponsors contend that these requirements create unnecessary hurdles for patients who urgently need care, often resulting in extended wait times for critical treatments.

Contention

Supporters of A4975 argue that the current system over-complicates accessing healthcare and places too much power in the hands of insurance companies, which can prioritize cost-saving measures over patient welfare. Critics may raise concerns about potential ramifications for cost management and oversight of healthcare services, questioning if the absence of pre-approval could lead to increases in unnecessary medical procedures and costs. Nevertheless, the bill's proponents maintain that the primary focus must be on immediate patient needs rather than bureaucratic restrictions.