S.4747

New Jersey S4747 mandates health insurers to explain denials of private duty nursing coverage.

New Jersey S4747 requires health insurers to provide a detailed reason for denying coverage of private duty nursing services. If a payer denies a prior authorization request for such services deemed medically necessary by a covered person’s physician, the payer must give a full description of the denial reason. If the denial is based on the services not being medically necessary, the payer must also explain why the physician's determination is invalid.