Fixing Out-of-Network Healthcare Costs

TRENTON, N.J., June 27 -- The New Jersey Business and Industry Association issued the following news release:

For more than two years, lawmakers have made a concerted effort to address the problem of "surprise" out-of-network healthcare bills that consumers wind up paying out of their own pocket even though they have insurance. Yesterday, the Senate Budget and Appropriations Committee approved legislation to address this contentious issue, and making it a possibility that out-of-network healthcare reform could become a reality this year.

NJBIA is urging lawmakers to vote on the measure before summer break and the fall legislative elections take center stage.

"This is a good bill that deserves to be passed Thursday," said NJBIA President and CEO Michele Siekerka in a statement released today. "It is a balanced and effective way to address an extremely difficult problem. The sponsors in both the Senate and Assembly have worked tirelessly over the last two years to get us to this point, and we should not let this opportunity go by. Let's finish the job."

NJBIA is supporting S-1285, sponsored by Senators Joseph Vitale (D-19) and Loretta Weinberg (D-37), as well as a companion bill, A-1952 (Coughlin, D-19; Schaer, D-36), which was released by the Assembly Budget Committee last fall and is awaiting action in the full Assembly.

"Out-of-network costs play an increasingly significant role in the rising cost of healthcare for both large and small employers in New Jersey, triggering both higher premiums and out-of-pocket expenses," said Mary Beaumont, NJBIA vice president for Health and Legal Affairs.

Out-of-network bills usually are caused by either emergency treatment, in which there's no time to find out whether an ER doctor accepts the same health plan as the hospital, or from scheduled procedures that require other providers besides the doctor, such as radiologists, pathologists, laboratories and others.

Out-of-network providers can balance bill patients for the difference between the insurance company's payment and the total charge. Bills from one illness can collectively total thousands or even tens of thousands of dollars, leaving patients who actually have health insurance buried in debt.

According to an article by Sue Livio of NJ Advanced Media, S-1285 would:

"...set limits on what hospitals and doctors outside of a consumer's network could charge for non-emergency care. It also would create an arbitration process to settle disputes, and require medical providers to disclose on their websites their in-network and out-of-network status with insurance companies.

"The latest version of the bill also contains a provision that allows self-insured, federally regulated insurance plans--representing 70 percent of New Jersey market--to voluntarily accept the bill's protections. The Legislature can only impose mandates on plans regulated by the state, such as Horizon Blue Cross Blue Shield of New Jersey and the State Health Benefits Plan."