Bill Seeks To Protect Against Unexpected Health Care Expenses

NJ Spotlight News | November 23, 2015 | Health Care
The ‘out-of-network’ act, aims to protect patients from surprise medical bills.

By Briana Vannozzi

It seemed like a done deal heading into today’s committee hearing but right off the bat, groups involved with the many re-writes of this legislation let it be known, they’re still not happy. Mishael Azam, COO of the Medical Society of New Jersey said, “we think it is a false narrative to suggest that a small number of outlier out-of-network physicians raise premiums.”

The so called, ‘out-of-network’ act, aims to protect patients from surprise medical bills. Those services given by a doctor or hospital, not included in the patients’ insurance network.

Assemblyman Craig Coughlin, Chair of the Financial Institutions and Insurance Committee said, “I don’t know anyone who hasn’t had someone gone to the hospital, have a procedure done and then get a surprise bill for the coverage.”

Under the measure, hospital officials would be legally required to share what’s covered and what’s not before treatment takes place. The bill has been in the works for several years most recently amended and shelved this past spring, proving just how complicated it is to discern New Jersey’s tangled web of medical billing.

Assemblyman Coughlin continued “The state will save, the cost to taxpayers will be reduced by somewhere between 22 and 92 million dollars. That’s real money I think that’ll have an effect on the budget.

Bill sponsors say they’ve spent countless hours with stakeholders before finalizing the legislation. One of the fruits of that labor is a redesigned dispute process. If a patient receives involuntary out-of-network service, the insurance carrier, hospital or doctor can enter into arbitration. That will also include a peer review process and that’s where the bill got snagged, yet again, today.

“Under the system set up in this bill the only person asking for arbitration would be the provider and the only reason a provider would ask for that arbitration is because 30 days after the service has been rendered, he hasn’t gotten paid yet,” said Tim Martin, the Outside Council for the Medical Society of New Jersey.

“We don’t want to see quality physicians be squeezed out or pushed down and delayed by deeper pocket insurance companies, so it’s a little bit disingenuous to say to talk about the length of time when in fact the added length of time comes from your clients asking us to insert a provision in there which elongates the time period,” added Assemblyman Troy Singleton.

Representatives for medical providers and hospitals say their main point of contention is that this bill would give more power to insurance companies, while taking it away from physicians. They’d like the legislature to consider the problems with cost both IN and OUT of networks.

Opponents argued arbitration will be costly and favor insurance companies. They also say most health insurance plans for New Jerseyans fall under federal rules and this litigation will do nothing to protect them anyway. Despite all the back and forth, the measure and a partner bill to collect data on health care costs advanced out of committee today. Sponsors hope to get it passed before the end of session in January.