Assemblywoman Holly Schepisi is sponsoring legislation (A-4401) which would prohibit insurance companies from requiring pre-certification for tests or procedures that are done on an emergency basis, regardless of whether treatment takes place in a hospital emergency room, at an out-patient facility or physician’s office.

“People with health insurance shouldn’t have to jump through hoops just to satisfy insurance companies when their life depends on it,” said Schepisi, R-Bergen and Passaic. “Waiting a day for insurance companies to decide where a test can be performed is unnecessary and can be life-threatening. Insurers should cover the costs in an urgent situation, regardless of where the test was performed.”

Schepisi cited an instance in her district when a specialist ordered a specific test for a patient who was at risk of having a blood clot. The insurance company demanded precertification for such a test to be done in the specialist’s office and instructed the man to wait as the precertification process would take at least a day. The specialist was concerned that if the man did indeed have a blood clot, he could die before morning. Instead, the specialist advised the man to leave his office and go immediately to the emergency room where there would be no question that insurance would pay its share of the test. Under Assemblywoman Schepisi’s bill, such an emergency test would be covered no matter where it is performed.