Mary Beaumont, Vice President
Along with the inauguration of Governor Phil Murphy, a new legislative session began last month. Assemblyman Craig Coughlin, prime sponsor of the surprise out-of-network medical billing reform bill, A-2039 (Coughlin, Schaer, Lampitt) / S-485 (Vitale/Weinberg) was also elected as Speaker of the General Assembly. This is good news and increases the likelihood that the bill can pass in the legislature. In addition, Governor Murphy’s Healthcare Transition Advisory Committee recommended reform of “surprise billing” and unfair out-of-network medical claim practices in their report.
Recently, NJBIA testified as part of a broad coalition of stakeholders— consumer groups, public employee unions, trade unions and other employer associations—to enact balanced and effective out-of-network reforms.
The bills could be released from Assembly and Senate committees as early as next week!
This legislation is necessary not only for employers, employees and all consumers, but also for the state to realize savings in the public employee health benefits plans. Estimates of savings to the state and consumers have ranged from $50 to $133 million annually. Ultimately, these costs impact every taxpayer in New Jersey.
This is a victory for business, but the work is not over yet.
We need your help to get A-2039/S-485 on the Governor’s desk! Please reach out to the Assembly Speaker and the Senate President, as well as your local legislators, and ask them to support this needed legislation.
Reasons to Support Out-of-Network Legislation Today:
- 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.
- This bill will decrease the high costs associated with surprise out-of-network billing by:
- Requiring healthcare providers to tell patients whether or not the providers they are scheduled to see are in or out of their network.
- Requiring health insurance carriers to keep their websites up-to-date. This will allow prospective patients to know who is currently in their network.
- Protecting you and your employees from out-of-network charges for medical services received in an emergency at out-of-network facilities or inadvertently from out-of-network healthcare providers.
I also want to hear from you, so please share your stories and experiences – and those of your employees – in dealing with “surprise” medical bills. You can contact me at MBeaumont@njbia.org
Recent news articles and press releases related to the legislation:
10 responses to “Out-of-Network Legislation Moving Forward in New Legislative Session”
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The out of network benefits definitely should stay. When you go to in-network provider, the insurance carrier tells the doctors in their network which procedures they can or can not perform as well as which medications they can prescribe. Insted of the doctors the insurances dictate the patients what are they allowed to do and in cases when they don’t comply insurances simply don’t pay for that.
The very few out-of network doctors keep the medical services between the doctor and the patient.
Don’t let this bill to be passed or you will end up paying for it with your health!
Finally someone is staring the monster in the eye, but so far only staring.
The out of network problem is only the very tip of the iceberg. Is anybody addressing out of control hospital charges? Is anybody questioning why is it that hospitals charge insurance companies “negotiated” rates and individuals the full list prices? Is anybody questioning whether those list prices are predatory? Maybe we should.
It is the responsibility of the patient to know there plan. Verifying a doctor or hospitals participation in a plan can be achieved via the health insurance company’s website, the physicians website or by calling either entity. The cost of services can be verified before services are rendered in most cases. You are free to choose the physician if your choice. I am shocked that any organization that promotes business welfare would support restrictive practices against another profession. Let the free market determine which providers thrive and fail. Be careful what you wish for…..your business could be next.
I was going to note that this bill is addressing the horse that is already out of the barn. If people look carefully at their insurance plans they will find their “out-of-network” plan is really paying only 110-150% of Medicare and that their high premiums are getting nothing close to what they did 2-3 years ago.
But I won’t go down that road because Mr Migliaccio’s comment above was a better response to an NJBIA position than anything I could write.
This bill does not eliminate out-of-network benefits. It does strengthen disclosure requirements for the voluntary decision to select and use the services of an out-of-network healthcare provider under your health benefits plan.
More importantly though, it addresses those situations where where people have done all their homework, checked to make sure all the healthcare services will be provided by in-network providers, but inadvertently, during surgery for example, are treated by an out-of-network provider and receive a bill for the balance between what their health plan will cover, and the provider’s fee. These “surprise” bills increase everyone’s costs.
I looked on the website for the cost estimator before a procedure. It was listed at $1286. I received a bill for $1802! When I questioned them, they told me they were sorry that perhaps the website was not up to date. I did my due diligence and was still met with a bill almost $600 higher than expected.
There will be no doctors around to take care of emergency.
If baseball arbitration is done and they say the doctors should accept Medicare rates because they participate in Medicare, then doctors will drop Medicare.
Who will suffer. The patient are usually held harmless by state laws. This bill only benefits the insurance companies
This is great. I think at a mature IT Services firm, all work is performed and documented through tickets, which have MINUTES associated with them, so incorrect billing is not possible. At a low tech IT firm, where you get a bill that says “Stuff, then you risk bad billing.
This is great. I think at a mature IT Services firm, all work is performed and documented through tickets, which have MINUTES associated with them, so incorrect billing is not possible. At a low tech IT firm, where you get a bill that says “Stuff, then you risk bad billing.
The networks were started by the insurance companies to save them money. When the doctors balked because they wanted to charge their normal fee instead of settling for a percentage, the insurance companies threatened their livelihood by calling them “out of network”. The insurance companies tell the patients they’ll save money by going “in network”, but what they really mean is the patient is still going to pay a high premium but the insurance companies are going to pay the physician less. The problem is not with physicians. The next time you’re sick, go to your insurance agent. He’s already got your money.