Menendez, Others Try to Stop Surprise Out-of-Network Medical Bills

Advocates say loopholes in New Jersey law would be closed if bipartisan federal measure succeeds

Bridget Devane, the public policy director for the Health Professionals and Allied Employees labor union, stood behind Sen. Bob Menendez in support of his federal legislation, the Stop Surprise Medical Bills Act. She said the bill would close loopholes in the law on out-of-network medical bills that Gov. Phil Murphy signed last year.

“In New Jersey we have many large employers who have what are called self-funded plans. Their employees are in a self-funded plan and it is held to federal regulations, not state,” Devane said. “…in the Jersey consumer protection law that passed for out-of-network, there was language put into the bill so any federal plans could opt in.”

But Devane said many are waiting to see how New Jersey’s law plays out before opting in. She gives the example of large health systems that have self-funded plans. “They’re on both sides of this. They are the providers, and they’re also the insurance side of this,” she said.

This new bill, Devane said, would protect all Americans with insurance — people like Meredith Ribeiro, who was shocked when she got a bill for over $1,000 from the anesthesiologist at the hospital where she gave birth.

“My OB was in network, my doctor was in network,” Ribeiro said.

Only standard in-network copays would apply

“Under our legislation, patients would only be charged their standard in-network copays fees when they unexpectedly receive care from an out-of-network doctor or hospital. In fact, our bill removes patients from the hassle of settling out-of-network claims altogether, instead creating an independent mediation process for providers and insurers seeking to work out their billing disputes,” Menendez said. “If these parties can’t reach an agreement, we require that doctors and health providers be reimbursed at the typical in-network rate for their region.”

A House version of the bill, championed by Rep. Frank Pallone (D-6th), doesn’t include a provision for mediation.

New Jersey Doctor-Patient Alliance president Dr. Peter DeNoble explains why an independent mediation process is important.

“If there’s no fair dispute-resolution process, this could have a very negative effect on patients, ultimately because if a doctor isn’t going to be fairly reimbursed for at least some of the services they provide, they’re going to think twice about waking up at 3 a.m. and providing those emergency-care services,” DeNoble said.

President Donald Trump has said he supports ending surprise medical billing in some form. Menendez said the bill has 21 bipartisan co-sponsors and he hopes to get it through the Senate soon.