Out-of-network billing practices are a place to start. Insured consumers are currently protected from out-of-network bills in emergencies. New Jersey law requires your insurer to cover emergency costs whether or not the hospital you go to is in your insurance network. Not surprisingly, some unscrupulous for-profit health care companies are exploiting this protection, staying outside of insurance plan networks in order to charge excessively high prices they know insurers must pay. Practices like this contribute to New Jersey's having the highest health care premiums in the nation.
The same protections do not apply to the care individuals get at in-network facilities in non-emergency situations. This puts consumers on the hook for higher costs of care they unknowingly received from an out-of-network provider.
Consumers should never face surprise out-of-network bills. A bill recently introduced in the New Jersey Legislature, the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, would end this practice. It would require doctors and hospitals to give consumers advance notice about which insurance networks they participate in and an estimate of what their care will cost.
Protections would be extended so consumers who go to an in-network hospital or surgical center and inadvertently receive care from an out-of-network doctor cannot be held responsible for higher out-of-network rates. Instead, the doctor and the insurer would have to negotiate a fair price, through arbitration.
The cost that providers charge for health care services affects us all. Letting doctors and hospitals continue to charge anything they want and leaving consumers with no ability to hold them to reasonable pricing through arbitration is not an option. This legislation offers a solution that is both reasonable to providers and payers and protective of consumers.
Unfortunately, for some for-profit health care companies that rely on out-of-network billing to increase profits and pay shareholders, the idea of reasonableness is anathema.
Some health care companies such as CarePoint have mounted a campaign to block this bill, saying they will be forced to close hospitals, eliminate jobs and abandon the communities they serve if the bill passes. The recent failure of this bill to be voted out of committee, despite strong support from consumer, business and labor groups, hospitals and payers, seems to indicate CarePoint is having some degree of success.
Care Point's Bayonne Medical Center was recently named No. 2 in the nation for having the highest pricing compared with actual costs. In 2013, it was listed as having the highest charges for 14 out of 15 of the most common Medicare inpatient procedures among all U.S. hospitals.
Reasonable reimbursement rates need not be a threat to any provider or hospital in New Jersey. Nor should a solution to this problem be abandoned in deference to a handful of companies that want to continue to profit from these unfair practices. Some large urban hospitals have stepped up to support this bill. The New Jersey Legislature should commit to passing it, to make the health care billing practices in New Jersey fair and reasonable for the insurers, the health care service providers and, primarily, all health care consumers in the state.
Maura Collinsgru is health care program director of New Jersey Citizen Action.