N.J. lawmakers clamp down on 'surprise' medical bills

Source NJ.com Health
A state Assembly committee Monday approved legislation that aims to protect consumers from getting socked with surprise out-of-network medical bills — addressing a problem in New Jersey estimated to cost nearly $1 billion a year.
The measure would require hospitals and doctors to reveal whether they are part of a patient’s insurance network before treatment occurs. It would also create a state-regulated binding arbitration process to settle disputed bills for out-of-network emergency care.
Lawmakers have tried to pass legislation reining in surprise bills for more than eight years but have been stymied by influential lobbyists representing doctors, hospitals and insurance carriers fighting over the details.
Medicare rates vary by procedure and patient but they always fall short of what it costs a doctor or a hospital to treat a patient, said Mishael Azam, chief operating officer for the Medical Society of New Jersey, a physician organization.
John Azzariti, president of the New Jersey State Society of Anesthesiologists, agreed, arguing the bill allows insurance companies to “dictate our reimbursement, much like Medicare.”
“It’s not sustainable to maintain a practice under those conditions,” Azzariti said, predicting the bill, if enacted, would drive physicians out of the state.
The Assembly Insurance and Financial Institutions Committee approved the bill by a 9-3 vote, although even supporters said they had concerns about how the arbitration system would work.
The bill was praised by consumer advocates like Ray Castro of New Jersey Policy Perspective. An estimated 168,000 people in the state receive an out-of-network bill they did not anticipate every year for an average $2,500. It also requires hospitals post on their website a list standard charges for the services they provide, and the list of doctors and their contact information who are employed by or have a contract with the hospital.
“Surprise bills are driving up the cost of insurance and unfairly penalizing New Jerseyans who do all the right things — buying insurance and using in-network providers,” said Maura Collinsgru, health policy advocate for N.J. Citizen Action, a consumer and labor group.
The bill would have little effect on self-funded, federally regulated insurance plans who are not bound by state law, representing 70 percent of New Jersey residents. Coughlin said self-insured companies may opt-in and will do so because they want to participate in the arbitration process.
The committee also approved a companion bill that would create a healthcare price index containing billing claims data to serve as a source for policy makers to monitor health care costs and efforts to contain them.
“Far too many New Jersey families — even those with quality health benefits plans — find themselves fighting over thousands of dollars in out-of-network charges they never even had the opportunity to review, let alone agree to, prior to receiving medical attention,” said Assemblyman Craig Coughlin (D-Middlesex), a sponsor of the bill and committee chairman.

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