POLITICS & GOVERNMENT

Bill aims to protect patients from surprise medical costs

BY Briana Vannozzi, Correspondent |

John Peterson of Little Egg Harbor received a surprise medical bill in the mail last year after undergoing treatment and tests at his local hospital for a vestibular issue.

“I said, ‘Is this in-network?’ ‘Yes,’ and then I left. I went back for the final exam and a few weeks later I got a bill for $1,600. I called my health insurance and they said, ‘You have to work it out with your doctor.’ I called my doctor and they said, ‘You have to work it out with your health insurance,'” he said.

Peterson shared his story with the Assembly Financial Institutions and Insurance Committee Monday morning, as lawmakers — particularly the new Assembly Speaker Craig Coughlin — worked to reignite a measure aimed at protecting patients from surprise out-of-network medical bills.

“Only patients in two situations, emergent and inadvertent scenarios, are protected from balance billing. The common denominator in those two things is that in each of those situations the patient has no ability to make the determination. They are situations where they have no control,” said Coughlin.

Advocates argue bills not covered by an insurance carrier amount to $1 billion a year in the state. But in a lengthy testimony, opponents said the issue is not with out-of-network coverage, but the in-network abuses, lack of transparency by insurance providers for scheduled fees and rates, and a clause that creates a baseball-style arbitration for doctors to negotiate prices.

“I do not want any of my patients to receive a surprise medical bill. I took an oath not to harm patients and for me, that definitely includes economic harm … Unfortunately, in my 30-year experience, what I found is that the surprise in the bill is actually how little insurance companies will pay for legitimate medical care,” said Dr. John Poole, president-elect of the Medical Society of New Jersey.

“We should immediately and separately, in a separate bill, stop any of those surprise bills, period, end of story,” said Assembly Minority Leader Jon Bramnick. “But what we are doing here is merging that serious transparency issue with the issue of fair compensation to doctors.”

Meanwhile, over in the Senate Budget Committee, stakeholders were on high alert as lawmakers were getting ready to hear a controversial bill that would give financial help to the state’s nuclear power plants and other clean energy initiatives. That bill was pulled late last session, causing an uproar. And Monday, it didn’t get any further.

“So if you’re here for that bill, that bill is being held,” said Senate Budget Committee Chair Sen. Paul Sarlo.

“Since we were working over the weekend on it, obviously I couldn’t put a bill forward as controversial as that without anybody seeing it. So we’ll have something pretty soon,” said Senate President Steve Sweeney.

The committee did move forward with a few other controversial items, including a measure to increase salaries for judges, prosecutors and other cabinet members, and another to transfer the management of the pension fund for police and firefighters out of the state’s control to a locally-operated board. That cleared the hurdle, but like everything else in Trenton, there’s likely more to come.