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Bill

Bill

A 5793

Prohibits health insurance carriers from denying payment of claim while seeking coordination of benefits information.

2024-2025 Regular Session Introduced by Lou Greenwald

New Jersey bill prohibits health insurers from denying claim payments while gathering coordination of benefits information, requiring faster reimbursement even during multi-insurer verification processes.

Introduced in the Assembly, Referred to Assembly Financial Institutions and Insurance Committee
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Bill Summary · A 5793

Legislative bill overview

Bill A 5793 prohibits health insurance carriers from denying payment on insurance claims while they are in the process of gathering coordination of benefits (COB) information from other insurers. The bill aims to prevent insurers from using the COB process as a reason to delay or withhold claim payments to patients or providers.

Why is this important

Coordination of benefits determines the order in which multiple insurers pay claims when a patient has coverage from more than one source (employer, spouse's plan, Medicare, etc.). Currently, insurers can delay claim payments indefinitely while requesting this information, potentially leaving patients responsible for bills or forcing providers to absorb costs. This bill would require insurers to pay claims promptly while still gathering COB details.

Potential points of contention

  • Insurance industry burden: Insurers argue they need time to determine payment responsibility and prevent duplicate payments or overpayments, which could increase fraud risk
  • Cost implications: Requiring upfront payment while determining COB liability could increase insurance premiums or reduce insurer profitability
  • Timeline clarity: The bill doesn't specify a reasonable timeframe for insurers to complete COB inquiries, creating ambiguity about compliance expectations
  • Subrogation complications: Paying claims before confirming another insurer's liability could complicate the process of recovering overpayments from primary insurers

Compiled from official sources — confirm details with the bill’s official record.

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