Surprise medical billing is an issue whose time has come. New Jersey passed a law last year tightening up on the practice. Now U.S. Rep. Frank Pallone, chairman of the powerful House Energy and Commerce Committee, wants to do the same for hospital patients throughout the country.
“They’re going to the hospital that’s in their insurance network but they’re finding out that some doctors — for example, often the anesthesiologist — is not in network and so when they go home, lo and behold, a month or so later they get a bill from the anesthesiologist,” said the Democrat, who represents New Jersey’s 6th District. “I don’t want to pick on them because it could be anybody, right. It’s a typical situation, and that bill could be $1,000, $10,000, who knows.”
Under Pallone’s bill, there would be no surprise billing allowed for emergency-room procedures, out-of-network doctors in the ER would be paid at the median in-network rate, and patients would get to approve all assisting physicians beforehand.
“You go into the emergency room, that is not the time to ask as you’re laying there and brought in on an ambulance whether the doctor is in your network or not. And what are you going to do if they say no,” said Assembly Speaker Craig Coughlin (D-Middlesex).
Coughlin was a sponsor of the New Jersey bill and said it took 10 years to get it through the Legislature. Now the federal bill Pallone is pushing has even the support of President Donald Trump.
“They weren’t told by the doctor, they weren’t told by the hospitals in the areas they were going to, and they get what we call a surprise bill — not a pleasant surprise, a very unpleasant surprise, so this must end. We’re going to hold insurance companies and hospitals totally accountable,” Trump said in May.
Advocates on board
The New Jersey law only covers about 30 percent of the state. Large unions and large corporations that self-fund their healthcare are exempt. The federal law ropes them into the new set of rules. Healthcare advocates are enthused.
“It’s great to have chairman Pallone and members of Congress really behind this effort, and we think it will be a real game changer for healthcare consumers across the country,” said Maura Collinsgru, healthcare program director at New Jersey Citizen Action.
Doctors groups are lukewarm about the reforms. The president of the Medical Society of New Jersey, Dr. Marc Levine says: “We have concerns with the legislation designed to address surprise medical bills resulting from inadequate insurance coverage. We are pleased the legislation was amended to include a dispute resolution mechanism but remain concerned the level of payments are based on insurance company unilateral decisions.”
Balance that against stories like one from a nurse at a New Jersey hospital who had a medical crisis in her own ER.
“She was unconscious by the time she was shipped out. She had no say on where she went. She couldn’t speak. She went to an out-of-network hospital and was hit with a half-million dollars in medical bills,” said Bridget Devane, public policy director with Health Professionals & Allied Employees.
The No Surprise Act has passed committees in the House and the Senate with bipartisan backing. Pallone said he expects the president will sign it sometime this fall.