A coalition of healthcare providers is seeking the intervention of New Jersey legislators to correct the state’s Personal Injury Protection, or PIP, medical fee schedule.

The New Jersey Supreme Court recently denied an appeal by the Alliance for Quality Care regarding the fee schedule proposed two years ago by the New Jersey Department of Banking and Insurance for reimbursing doctors who treat auto injuries.

The Alliance sought to overturn an August 2009 decision by a state appellate court, which sided with state regulators on the new fee schedule, ending two years of appeals on the matter on behalf of eight state provider groups, who claimed the fee schedule did not reflect “the reasonable and prevailing fees” of providers in the region.

New Jersey Insurance Commissioner Neil N. Jasey said his department views the implementation of the PIP fee schedule “as a means to help contain health care costs associated with automobile accidents, exerting downward pressure on insurance rates and greatly benefiting New Jersey’s auto insurance consumers.”

Fee schedule ‘arbitrary’

The Alliance for Quality Care, however, has a different view on the fee schedule.

“The litigation component of this battle is over,” the Maplewood, N.J.-based association said. “The war to reverse this injustice continues in the Legislature.”

The Alliance said it has “significant support” for a bill requiring the PIP fee schedule to be based on actual amounts paid by PIP carriers to medical providers. The bill would require the new fee schedule to be based on paid fee data from 2007, those rates in place before the current fee schedule went into effect.

“What is sad and troubling about the decision is that I am hard-pressed to think of a rulemaking process or a fee process the court wouldn’t uphold at this point,” Mark Manigan, counsel for the Alliance, told IFAwebnews.com. “The [fee schedule] from the agency is so arbitrary, we need legislators to come in and fix it.”

Manigan said the provider group is “cautiously optimistic” it can move the legislation forward and “working hard to get this problem fixed.”

This story originally appeared in the January 2010 print edition of Insurance & Financial Advisor.