HEALTH

Murphy signs out-of-network health care cost bill

BY Brenda Flanagan, Senior Correspondent |

Gov. Murphy today signed a bill designed to shield Jersey residents from the nasty surprise that often follows an emergency room visit or hospital stay, those unexpected bills from out-of network health care providers. Last year, 168,000 New Jersey patients owed $420 million for treatments they didn’t preapprove, or even know about. The Assembly Speaker Craig Coughlin talked about his gall bladder surgery.

“I went in through the emergency room, it all should be covered. And then we got a bill from a doctor. And we started the process of fighting through it. Ultimately, they put me in collections. And finally we worked it out,” Coughlin described.

“Residents should not have to worry whether an emergency trip to the hospital could be potentially bankrupting,” said Gov. Murphy.

It’s a long-festering problem that’s taken a decade for New Jersey politicians to treat. A recent poll showed the issue affects one in seven New Jersey residents, especially low-income patients who can least afford to get blindsided by big bills. Part of the challenge facing consumers.

“You may get bills from four, five different doctors, from two or three different facilities, maybe even an ambulance bill. And of course, in the middle of a health crisis, you don’t want to worry about what doctors you’re seeing. You want your health taken care of,” explained Joel Cantor, the founding director of the Center for State Health Policy at Rutgers University.

Under the new law, health care providers must inform consumers about any possible out-of-network services, before they’re performed, and how much patients are expected to pay. Insurers must update lists of network providers. Providers must restrict excess charges for emergency out-of-network services, pursuant to a patient’s health coverage. And out-of-network billing disputes must go to arbitration. But lower rates could yield a bad prognosis for some doctors, analysts say.

“We hear about physicians in New Jersey retiring early, relocating. We have some physicians where there’s a shortage of their specialty. It’s just added frustration to the desire to do good for patients,” argued John Fanburg, an attorney and chair of health law practice at Brach Eichler.

“I don’t begrudge anyone to make a good living,” said Sen. Joe Vitale, a sponsor of the bill. “I don’t count anyone’s money. But at the end of day, greed can’t take the place of what is the right thing, which is to charge a fair amount for your services, get paid whatever it is. You guys duke it out. But leave the consumers out of it, that’s not their job.”

The bill also allows self-insured plans to opt in. The out-of-network protection law’s expected to save state government $80 million taxpayer dollars, too. It takes effect in 90 days.