January 3, 2025
State-regulated health insurance companies will now have less time to decide whether to cover treatments and tests prescribed by patients' doctors. As reported in yesterday's Star Ledger, "Insurance carriers will have tighter deadlines in the state to decide whether to approve a prescribed test, medication or treatment - 24 hours for 'urgent' requests and 72 hours for non-urgent requests. A prior authorization for treatment of a long-term or chronic condition shall remain valid for 180 days."
According to legislation (A1255), those who decide to switch health plans will receive care under their old plans' prior authorizations for 60 days. "For years patients have had to endure the hardship of being left in the breach when they seek vital care only to have their access to that care interrupted by what all too often seems to be an onerous and draconian process," Assemblyman Sterley Stanley, D-Middlesex, one of the legislation's sponsors, said after it passed the 80-member lower house. "This bill addresses that reality and will not only provide patients with more efficient access to care, but does so in a way that does not jeopardize the ability of insurance carriers and pharmacy benefit managers to fulfill their responsibility to be good financial stewards of the care they are entrusted with managing."
Read the article here and a related bulletin from the New Jersey Department of Banking and Insurance here.
