New Jersey’s healthcare billing laws protect you from surprise balance bills after emergency or inadvertent out-of-network care, cap how medical debt can be collected and reported, require providers to disclose their network status and prices before non-emergency treatment, and give you complaint channels at the state level when a bill or a collector breaks the rules. The two laws doing most of the work are the Out-of-Network Consumer Protection, Transparency, Cost Containment, and Accountability Act of 2018 and the Louisa Carman Medical Debt Relief Act of 2024. Together with federal law, they cover most of the situations where a patient gets an unexpected bill.
When You Cannot Be Balance Billed
The 2018 Out-of-Network Consumer Protection Act (P.L. 2018, c.32), effective August 30, 2018, targets the two situations that produce most surprise medical bills.1NJ Department of Banking and Insurance. Out-of-Network Consumer Protection The first is emergency or urgent care from an out-of-network provider. The second is “inadvertent” out-of-network care, meaning you go to an in-network hospital or facility but a doctor, anesthesiologist, or other specialist who treats you turns out not to be in your plan’s network.
In both situations, the provider cannot bill you for anything beyond your in-network cost sharing. That means your normal deductible, copayment, or coinsurance, and nothing more. The practice of sending you a bill for the gap between the provider’s full charge and what your insurer paid, called balance billing, is prohibited outright for these services.2New Jersey Legislature. P.L. 2018, c.32 – Out-of-Network Consumer Protection Act
The protection also reaches laboratory work. If your in-network doctor orders lab tests and sends the samples to an out-of-network bio-analytical lab, you cannot be balance billed for the lab charge.2New Jersey Legislature. P.L. 2018, c.32 – Out-of-Network Consumer Protection Act That closes off one of the more invisible sources of surprise bills, since patients rarely see who handles the sample after it leaves the office.
There is one important exception. If you “knowingly, voluntarily, and specifically” chose an out-of-network provider, the balance-billing ban does not apply. Choosing to see an out-of-network specialist for a scheduled procedure, after being told what you were doing, puts the bill back on you. The disclosures described further down are how providers document that choice, and how you can catch it before it happens.
Which Health Plans These Rules Cover
The Act applies to fully insured health plans regulated by New Jersey, including the State Health Benefits Program.1NJ Department of Banking and Insurance. Out-of-Network Consumer Protection Self-funded employer plans, which many large employers use and which are governed federally under ERISA, are not automatically covered. New Jersey does let self-funded plans opt in voluntarily; if yours has, your insurance ID card will show the notation “NJ arbitration – YES.”
The law does not apply to Medicaid, Medicare, Medicare Advantage, workers’ compensation, or auto PIP coverage.2New Jersey Legislature. P.L. 2018, c.32 – Out-of-Network Consumer Protection Act If your bill comes through one of those programs, a different set of rules governs it.
The federal No Surprises Act, effective January 1, 2022, fills most of the gaps. Self-funded plans that have not opted into New Jersey’s system are covered by the federal balance-billing protections instead, and any part of a bill that falls outside the state definitions is picked up federally.3Centers for Medicare and Medicaid Services. No Surprises Act and State Laws For most consumers in New Jersey, one law or the other applies.
What Providers Must Tell You Before a Non-Emergency Procedure
The strongest way to avoid a surprise bill is to be told about it in advance, and the 2018 Act puts that duty on both facilities and individual clinicians.
Before scheduling a non-emergency procedure, a hospital or facility must tell you whether it participates in your insurance network, and it must advise you to verify that the physicians who will treat you are also in-network.2New Jersey Legislature. P.L. 2018, c.32 – Out-of-Network Consumer Protection Act Facilities must make their standard charges available and post the plans they participate in on their websites.
Individual healthcare professionals have their own duty. Before delivering a non-emergency service, they must disclose their network status in writing. If they are out-of-network, they must, on request, give you an estimated bill with the relevant CPT codes and remind you that you will be financially responsible.2New Jersey Legislature. P.L. 2018, c.32 – Out-of-Network Consumer Protection Act Ask for that estimate. It is your best evidence later if the actual bill is higher.
Insurers have obligations too. They must keep provider directories current on their websites, publish clear information about out-of-network coverage with cost examples, provide treatment-specific cost estimates on request, and run a consumer hotline available at least 16 hours a day.1NJ Department of Banking and Insurance. Out-of-Network Consumer Protection
Hospital price transparency at the state level is weaker in practice. A 2024 review by a patient advocacy group found that only 3 of 32 New Jersey hospitals examined were complying with federal price disclosure rules. A pending bill, Assembly Bill A5376 introduced in February 2025, would create an oversight commission with enforcement powers and bar non-compliant hospitals from collecting medical debt, but as of mid-2026 it had not moved past introduction.4New Jersey Monitor. Legislators, Advocates Renew Fight to Cap Soaring Hospital Costs
Your Protections Once a Bill Goes to Collections
The Louisa Carman Medical Debt Relief Act (P.L. 2024, c.48), signed July 22, 2024, governs what a medical creditor or debt collector can do after you fail to pay. Credit reporting restrictions took effect immediately; the broader rules on collection activity, interest, and wage garnishment took effect July 22, 2025.5Justia. N.J. Rev. Stat. § 56:11-59
Credit Reporting
Medical creditors and debt collectors cannot report any medical debt to consumer reporting agencies for services performed on or after the law’s enactment. Consumer reporting agencies cannot include paid medical debt, or any medical debt under $500, in a consumer report, regardless of when it was incurred. If a debt gets paid or you file an insurance appeal, the creditor must tell the reporting agency to delete the entry.6New Jersey Legislature. S2806 – Louisa Carman Medical Debt Relief Act Any portion of a medical debt reported in violation of these rules is void.
When Collection Can Start
A creditor cannot begin collection activity until at least 120 days after sending the first bill, and only if it has offered you a “reasonable payment plan.” Before taking further steps, the creditor must send another bill and a written notice at least 30 days in advance describing what actions it intends to take. Every collection communication must include a clear statement confirming the debt has not been reported to a credit bureau.5Justia. N.J. Rev. Stat. § 56:11-59
What a Reasonable Payment Plan Looks Like
A payment plan qualifies as reasonable if it meets all of these terms: monthly payments no higher than 3% of your monthly income, a repayment period between three months and five years depending on the debt amount, a grace period of at least 60 days for a late payment, an interest rate capped at 3% per year, and terms that can be adjusted if your financial situation changes.5Justia. N.J. Rev. Stat. § 56:11-59 Accepting a plan is not an admission that the debt is valid, and once you’re complying with one, the creditor cannot pursue other collection actions.
Interest and Wage Garnishment
Interest on medical debt is capped at 3% per year. Wage garnishment for medical debt is prohibited entirely if your annual income is below 600% of the federal poverty level. A creditor that sells medical debt has to bind the buyer, by contract, to the same rules: no credit reporting, no reselling, no collection beyond what the Act permits.6New Jersey Legislature. S2806 – Louisa Carman Medical Debt Relief Act
Violations are treated as unlawful practices under the New Jersey Consumer Fraud Act. The Attorney General can assess civil penalties and order restitution.
How to File a Complaint or Dispute a Bill
Where you complain depends on what went wrong.
- Insurance and balance-billing disputes. The Department of Banking and Insurance runs the Consumer Inquiry and Response Center. File online, mail to NJDOBI, PO Box 471, Trenton, NJ 08625-0471, or call 1-800-446-7467.7NJ Department of Banking and Insurance. Consumer Information
- Hospital and facility complaints. The Department of Health’s Division of Health Facilities Evaluation and Licensing takes complaints online or on its 24-hour hotline at 800-792-9770.8NJ Department of Health. How to File a Complaint
- Individual provider complaints. The Division of Consumer Affairs handles complaints about physicians (Board of Medical Examiners) and nurses (Board of Nursing) at 973-504-6200.9NJ Division of Consumer Affairs. Division of Consumer Affairs
- Help paying a hospital bill. The Hospital Care Payment Assistance Program (charity care) can be reached at 866-588-5696.8NJ Department of Health. How to File a Complaint
Suspected healthcare fraud can be reported to the Division of Criminal Justice tipline at 800-277-2427 or dcjtipline@njdcj.org.9NJ Division of Consumer Affairs. Division of Consumer Affairs
If your first bill after an emergency room visit or an in-network hospital procedure includes a charge from a provider you didn’t choose and didn’t know was out-of-network, that is exactly the situation the 2018 Act was written for. Contact your insurer first, then DOBI if the bill isn’t corrected. Keep the original bill, any estimates or disclosures you were given, and your insurance card noting whether the plan is subject to New Jersey’s rules.