Disputing a Medical Bill in
New Jersey
Medical Billing Laws, Consumer Protections & Information
New Jersey
The State of New Jersey gives consumer protections and has other laws and regulations for patients receiving care from, or otherwise being billed by, a provider in the state. Here are some of the most important state-specific laws and protections related to medical billing in New Jersey.
OUT-OF-NETWORK FACILITY BILLING
A New Jersey hospital or facility must notify an insured patient prior to scheduling a non-emergency service if the provider does not participate in the patient’s insurance network.
OUT-OF-NETWORK PHYSICIAN BILLING
A New Jersey physician or professional must notify an insured patient prior to a non-emergency service if the provider does not participate in the patient’s insurance network.
COLLECTIONS PROTECTIONS - FINANCIAL ASSISTANCE
A hospital in New Jersey may not collect from a patient on a medical bill if it fails to inform the patient of medical assistance programs or does not refer a patient who could reasonably be considered eligible for a medical assistance program within three months of the date of service.
PRICE TRANSPARENCY
9%
Only 9% of the hospitals in New Jersey are compliant with the federal Hospital Price Transparency Rule requiring hospitals to publish their prices, according to an independent audit. If you received a bill from a non-compliant hospital, that can be a reason to dispute the bill.
MEDICAL DEBT IN
new jersey
7.4%
7.4% of people in New Jersey report having medical debt in a given year, on average.
HOSPITAL PRICES
6.7 x cost
The average hospital in New Jersey charges 6.7 times what it costs to render the services. That means for every $100 in cost, it bills $670, of which $570 is profit.
Medical Billing Laws & Consumer Protections
All of U.S.
These federal laws and consumer protections apply to
all 50 U.S. states and the District of Columbia.
NO SURPRISE BILLING
The No Surprises Act protects people using insurance from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.
GOOD FAITH ESTIMATE
A medical provider must issue a Good Faith Estimate in advance of services to a patient not using insurance. The Good Faith Estimate is a disclosure of expected services to be rendered and their charges.
BALANCE BILLING - EMERGENCY
A provider may not bill an insured patient for emergency services above the in-network payment responsibilities (coinsurance, deductible, copayment) under insurance benefits.
BALANCE BILLING - AT AN IN NETWORK FACILITY
For services an insured patient receives while visiting a participating hospital or facility, a provider may not bill the patient above the in-network payment responsibilities (coinsurance, deductible, copayment) under insurance benefits.
COLLECTIONS PROTECTIONS
The three nationwide credit reporting companies – Equifax, Experian, and TransUnion – do not include medical debts (1) below $500, or (2) less than a year old on consumer credit reports.
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