On July 18, the Supreme Court of New Jersey held that a health care provider has no duty, on account of an assignment of benefits executed by an insured, to provide an insurer with information relative to the provider’s ownership structure, billing practices or referral methods of the providers from whom an insured received treatment. The case is styled as Selective Insurance Co. of America v. Hudson East Pain Management, 46 A.3d 1272 (2012).
The case is interesting because it highlights the ambiguity that exists with many health care providers as to what obligations they have to divulge information to third-party payors. Providers may call their attorneys seeking guidance on their obligations when an insurer asks them for information or documentation. The case gives some guidance to New Jersey providers who are reimbursed under personal injury protection (PIP) benefits as to what their obligation is to insurers seeking information not about a patient’s medical history, but about their practice.
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