NJ could change how health insurance companies pay for tests, drugs

⚫ A proposal says insurance companies should pay for what the doctor orders

⚫ Health insurers would be blocked from requiring pre-approvals

⚫ The idea has been floating around Trenton for years

Brad Schnure believes the prognosis attached to his cancer diagnosis — instead of being terminal — would have been much brighter if insurance hadn't denied a relatively inexpensive scan about a year prior.

And he's perplexed by the fact that a family doctor from a third-party administrator denied him of an MRI that had been ordered by his neurologist, to see whether or not treatment was working.

"In effect, insurance companies are now middlemen in the doctor-patient relationship," Schnure said. "They're making important decisions about patient care, despite never having seen the patient."

Schnure, a former employee of the New Jersey Legislature, is hoping to see movement on a bill that would essentially prohibit health insurers and other entities from requiring pre-approvals and pre-certification for tests, procedures, and drugs that are already covered under one's benefits plan — if your doctor says you need something, your health insurance should cover it.

The idea has existed on paper for years in the New Jersey Legislature. The bill's sponsor, Sen. Jon Bramnick, R-Union, decided to hold a virtual press conference in late 2024 to put the proposal in the spotlight again.

To start the press conference, Bramnick condemned the alleged murder of UnitedHealthcare CEO Brian Thompson on Dec. 4 as the "worst example" of an "us versus them" society.

Bramnick, who's running for New Jersey governor in 2025, said the bipartisan legislation would ideally erase a "piecemeal approach" to pre-approvals by the New Jersey Legislature over the past few years. Should his bill become law, insurance companies pay for what the doctor orders.

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The bill calls for an end to the "nightmare of the insurance company bureaucracy that is frustrating patients who need care and medicine."

"There are outliers out there, who may actually over test, over treat for profit purposes. But I think that the insurance companies have the ability to weed out those people," Bramnick said.

A New Jersey law that took effect in January 2025 requires that insurance companies decide on pre-authorization cases within 24 to 72 hours of a request, depending on the severity of the case.

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