Requires health insurers to provide reason for denial of coverage for private duty nursing.

This New Jersey bill requires health insurers to explain in detail why they deny coverage for private duty nursing services that a patient's doctor has deemed medically necessary. When an insurer rejects such a request, it must provide a full description of the reason, specifically explaining why the doctor's assessment is invalid if medical necessity is the issue. Additionally, the law mandates that insurers share the criteria they use to evaluate these requests and give examples of approved cases along with the required documentation. These provisions aim to increase transparency in the approval process for private duty nursing by ensuring patients receive clear rationales for denials. The changes will take effect 90 days after the bill is enacted.