In our most recent e-newsletter, we ran a story by Vincent R. Zarate regarding a new medical fee schedule being proposed by the New Jersey Insurance Department. The new schedule prices 1,000 medical procedures for injuries suffered in automobile accidents (see full story at www.Insurance-Advocate.com).

Zarate now reports that the New Jersey Medical Society is opposing the new schedule. Zarate writes:

Raymond Cantor, director of governmental affairs for the society, said the society sees no need to change the existing schedule because it covers 85 percent of all claims for medical payments for persons injured in automobile accidents.

The society represents 6,000 doctors, and its support is crucial in the departments efforts to end existing disputes between insurance carriers and health care providers on the fees that should be paid.

The department is withholding comment because it said it has not officially received the objections.

Cantor said the existing schedule lists 92 medical procedures to treat accident victims with personal insurance protection (PIP) coverage. Since 1998, he pointed out, procedures not listed are paid at usual, customary, and reasonable rates.

He said the new proposal, however, does not include Level I and Level II trauma facilities, and instead sets the continuing care reimbursements of physicians at 150 percent of Medicare fees being paid.

Cantor said under the existing program, physicians are receiving reimbursement at 300 and 400 percent of Medicare and the new proposal cuts that by more than half in most cases.

He said the society also opposes the new fee schedule because it defines usual, customary, and reasonable to be the paid amount instead of the billed amount, and ignores non-insurance payments from the calculation, which in turn allows the insurance company to determine what is the usual, customary, and reasonable fee.

Cantor warned, Drastic cuts in reimbursement for these services will lower the number of physicians willing to take calls or will force already-trained hospitals to pay extra.