Out-of-network 'surprise' medical expenses bill continues in 2017

Legislation to protect consumers from getting bills for ‘surprise’ out-of-network medical expenses will continue in early 2017 after going on pause earlier this month.

State lawmakers, consumer advocates, health insurers and health providers have been on an eight-year mission to pass legislation that would regulate and control out-of-network medical bills that New Jersey patients may unexpectedly get.

The Senate bill, sponsored by Sen. Joseph Vitale, was put on hold last week when the Senate Budget Committee delayed its hearing because several stakeholders asked for more time to review amendments made just days before the hearing.

Vitale said the priority of the bill is consumers, and when all is said and done, they will be the ones who largely benefit from the legislation. It has taken years for involved parties to compromise on how to reduce balance billing, or extra medical billing, because the issue is so complex, he said.

Out-of-network charges from doctors, hospitals, health care providers and gaps in insurance coverage have become an increasing concern for patients. Supporters of the bill stated that about 168,000 consumers every year are charged large sums of money for unexpected medical bills.

Those charges have resulted in an additional $1 billion to New Jersey’s five million privately-insured consumers in the form of  higher premiums as a result of these out-of-network issues, according to research from the New Jersey Policy Perspective.

Maura Collinsgru, leader of New Jersey Citizen Action’s NJ For Health Care coalition, has represented consumer advocacy in bill discussions. She said the coalition’s primary concern, as aligned with the bill, is to fix a flaw in the health care system that disproportionately hurts people.

“Consumers do everything they should and can to make sure they are at an in-network facility, but yet they are still victimized by surprise bills,” she said. “This has to stop. And the indirect cost is something we all bear.”

Representatives from hospitals, other health care providers, health insurance companies and consumer protection groups all agree that the out-of-network billing practice is an issue, but coming to a solution that benefits all stakeholders is easier said than done.

"You might write in a certain provision, but because it’s so complex, it can have unintended consequences or impacts,” said Kerry McKean Kelly, vice president of communications at New Jersey Hospital Association.

The association represents many hospitals, health providers and professionals who want to ensure that they are still paid fairly for their work if out-of-network costs become the responsibility of the heath provider or insurance company.

A solution in both the Senate and Assembly versions of the bill is to pay hospitals and health care providers for this type of billing using reimbursement rates that MediCare uses. Health providers were initially concerned because MediCare rates are often below the cost of care, Kelly said.

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