N.J. health care coalition releases report backing out-of-network bill

A major New Jersey-based health care coalition released a report Wednesday in support of the passage of an out-of-network health care bill, which is currently being considered by the state Legislature.

In its report entitled “Surprise Medical Bills: What they are and how to stop them,” the NJ for Health Care coalition, in partnership with Consumers Union, detailed the ways in which health care consumers can unknowingly arrange for out-of-network services, only to be blindsided later on by a potentially hefty bill that is not covered by their providers.

“This is a growing problem that continues to expand and affect more and more New Jersey consumers,” said Maura Collinsgru, program director with New Jersey Citizen Action, which is responsible for convening the coalition. “It’s a statewide problem that demands a statewide solution. We need a health care system and solution that is transparent and fair and protects all consumers from these out-of-network surprise bills in the future.”

As it has currently been proposed, the legislation sponsored by Assemblymen Troy Singleton (D-Mount Laurel), Gary Schaer (D-Passaic) and Craig Coughlin (D-Woodbridge) and state Sen. Joseph Vitale (D-Woodbridge) would shield consumers from surprise out-of-network bills as well as provide protections when emergency care is received at both in-network and out-of-network hospital facilities.

Under the measure, out-of-network providers would bill a patient’s health care provider using a new payment system established by the legislation, which would set a health price index using data from actual paid claims for a given service. With the index serving as a median, the out-of-network provider would be able to bill a patient’s health care provider for 75 percent to 250 percent of the index and a mandatory arbitration process would be used to settle all disputed claims.

That arbitration process was the chief concern of many when the bill went before the Senate Commerce Committee in June. Lawmakers are expected to take the issue back up later this fall.

“The New Jersey Legislature has the power to stop this unfair practice in its tracks,” said Consumer Union Program Director Chuck Bell. “The bill now advancing in the Legislature would go a long way toward fixing this problem, but not if the special interests have their way. The physician associations and hospital systems who oppose this bill want to protect their right to continue bloated billing practices — even price gouging. These hidden practices are harming consumers. New Jersey needs to adopt protections that do away with surprise medical bills once and for all and reign in the excesses of out-of-network billing in general.”

States like Illinois and New York have already passed similar pieces of legislation.

“As the report details, this problem is incredibly urgent,” said report contributor and New Jersey Appleseed Public Interest Law Center Director Renee Steinhagen. “Consumers falling victim to this practice are struggling with medical debt and the practice is a major driver of increased health care costs for everyone in our state. We need the state to adopt a comprehensive and strong solution, and without delay.”

Original article