NJ bill would prohibit insurers from fee capping

Late last week, New Jersey's General Assembly took the latest step in a years-old dispute between insurers and the state dental association when it approved bill A-3411. This bill will forbid contractual clauses in which insurance carriers require dentists to provide out-of-plan services to insured at rates set by or subject to the approval of the carrier, which is currently allowed under New Jersey law.

Aetna and MetLife were sued in New Jersey state court by the New Jersey Dental Association (NJDA), which argued the state's selective contracting law forbids the programs. However, in May 2012, the state Superior Court's Appellate Division ruled for the insurers in a published decision, saying the NJDA failed to overcome the standard set by the court's de novo review, which presumes the validity of administrative regulations.

The bill now goes to Gov. Chris Christie for approval.