When you are making decisions about health care, consider other sources of information and assistance.
Department of Banking and Insurance
Buyers Guides and other information are available for individual and small employer coverage. This information is on the New Jersey Department of banking and Insurance’s (DOBI) web site at www.state.nj.us/dobi/reform.htm. You may also request information by calling (800) 838-0935 04 (800) 263-5912 and pressing option “2”. DOBI monitors the compliance of HMOs with New Jersey rules through in-depth reviews and targeted examinations. DOBI investigates consumer complaints about HMOs and other carriers offering managed care health benefits plans, and oversees the Independent Health Care Appeals Program (IHCAP) and the program for Independent Claims Payment Arbitration (PICPA), an arbitration mechanism that became operational in July 2007 to address certain claims disputes between health care providers and carriers. Certain data regarding complaints, the IHCAP and PICPA is (or will be) available. For information, visit www.state.nj.us/dobi/managed.htm or call the Office of Managed Care toll-free at (888) 393-1062, and press option “2”.
DOBI also posts information on enrollment by county and line of business, net worth and profitability for New Jersey HMOs, as well as other information on health carriers. This information can be found at www.state.nj.us/dobi/division_insurance/lhactuar.htm.
For information on managed care options for Medicare in New Jersey, call the New Jersey Department of Health and Senior Services, Division of Aging and Community Services, State Health Insurance Assistance Program (SHIP) at (800) 792-8820, or call
(800) MEDICARE. You can also visit www.medicare.gov. If you have a complaint about a Medicare managed care plan, refer to your member services handbook for detailed information about where to submit your complaint based on the type of complaint you have.
For information on NJ family Care/Medicaid HMO options, quality information and complaints, call the New Jersey Department of Human Services at
(800) 356-1561 or visit: www.state.nj.us/humanservices.
For information on New Jersey physicians, including disciplinary actions, call the New Jersey State Board of Medical Examiners at (609) 826-7100 or visit www.state.nj.us/lps/ca/medical/bme.htm.
Additional Health Care Information
The Department of Health and Senior Services (DHSS) publishes a number of reports and other data regarding, for instance, indicators of hospital performance, indicators of long-term care facility performance, and maintains a price comparison registry for many prescription drugs. You can access this information at www.state.nj.us/health/reportcards.shtml.
Large employers and unions often assume financial responsibility for employee health benefits instead of buying insurance. Employers may contract with outside organizations to administer their self-funded health benefits plans (sometimes referred to as “self-insured” plans). These plans are not bound by New Jersey’s statutory or regulatory requirements, but rather by federal rules. Roughly half of all New Jersey health benefits through employers are in self-funded plans. Questions or complaints about these self-funded plans can only be addressed by the federal Department of Labor’s Employee Benefits Security Administration. The main number is: (866) 275-7922. The web site is: www.dol.gov/ebsa.