The alliance argued that the $2,000 out-of-network cap violated state law because it was not within the “reasonable and customary”—or 80th percentile—range of prevailing healthcare charges.
The state's Banking and Insurance Department Commissioner Neil Jasey ruled that the alliance, as a third party, did not have standing to contest the case. He added that, even if it did, public interest does not favor a stay, and that any loss in income that providers may incur does not constitute a level of “irreparable harm” that would merit a stay.
“The approval of the plan constitutes a final agency decision,” Jasey wrote, adding that the state appellate court—and not his department—was the proper forum to challenge his June 12 approval of the plan.
Alliance attorney Mark Manigan, with Roseland, N.J.-based Brach Eichler, said the decision will be appealed in court, and that the issue of standing will be removed as three plaintiffs have signed onto the case: the New Jersey Association of Ambulatory Surgery Centers, Orthopaedic Surgeons of New Jersey, and the Roseland (N.J.) Ambulatory Surgery Center.
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