Current telehealth reimbursement under NJ payment parity laws for out-of-network providers?
Question about OON telehealth coverage in NJ:
According to https://www.cchpca.org/new-jersey/?category=private-payer&topic=parity, New Jersey currently has acting service and payment parity laws: Bill NJ S2559 and Statute C.26:2S-29
> A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the plan when delivered through in-person contact and consultation in New Jersey.
Am I reading this right that it applies to both in-network (contracted) and out-of-network (not contracted) providers? My plan has OON coverage (insurance policy from employer).
In other words, are private insurance companies in NJ bound by these laws that are currently in effect? Do they have to reimburse a telehealth OON office visit at 100% of their rate for a similar in-person face-to-face visit? Or does it only apply to visits with their in-network providers?
submitted by /u/TypicalFickleSeal
[comments]
