BULLETIN NO. 02-17

 

 

TO: ALL INSURERS WRITING AUTO INSURANCE IN THIS STATE WITH APPROVED DECISION POINT REVIEW PLANS

FROM: HOLLY C. BAKKE, COMMISSIONER

RE: USE OF NETWORKS; APPROVAL OF DECISION POINT REVIEW/PRECERTIFICATION REQUESTS

The Department has become aware that that some medical providers believe that automobile insurers or their vendors are withholding approval of decision point or precertification requests unless the patient agrees to go to a provider in a network maintained by the insurer.

The purpose of this Bulletin is to clarify that such a practice has never been authorized by the Department. The decision to approve a decision point or precertification request should be based only on the medical necessity for the treatment or testing.

Automobile insurers are permitted in their Decision Point Review Plans to contract with networks only: for certain types of diagnostic testing such as MRI's; for durable medical equipment; and for prescription drugs. Networks of treating providers are not permitted. Just as in health insurance, patients that opt not to use the insurer's approved network are subject to an additional co-payment.

Any instance where approval of decision point or precertification request has been conditioned on use of an insurer's network should be reported to the Department at the following address:

 

Division of Insurance
Enforcement and Consumer Complaints
P.O. Box 329
Trenton, N.J. 08625-0329

Fax: (609) 292-5865


9/24/02 /s/ Holly C. Bakke, Commissioner