The New Jersey Department of Banking and Insurance has published proposed amendments to the state’s Health Benefit Plan regulations that would affect chiropractic reimbursement. 

According to Jeff Randolph, Esq. general counsel to the Association of New Jersey Chiropractors, the proposed amendments would limit patient responsibility for in-network co-pays to an amount that cannot exceed 50 percent of the cost of the service. 

In addition, the stacking of network co-pays and coinsurance would not be permitted, and individual and family annual out-of-pocket limits would be required to be established. When those limits are reached, the patient would be exempt from any further out of pocket expense for the remainder of the year.    

The proposed regulation would stop the trend that patient

cost-sharing eats up most, if not all, of the benefit and results in checks being sent to chiropractors for $1.50 in reimbursement because of excessive patient cost sharing provisions. 

The proposed regulations would also greatly expand the annual and lifetime dollar maximums allowed under insurance plans as well as cap dental out of pocket cost sharing to 75 percent of the cost of the service.

The proposed regulations are now out for public comment with the comment period expiring March 22, 2008. The ANJC will be submitting official comments in favor of the proposed regulations and will keep you advised throughout the process. 

The proposed regulations may be viewed in full at www.state.nj.us/dobi/proposed/prn08_16.pdf