NJ Dems Propose Bill to Reduce Out-of-Network Health Care Costs

By Michael Hill

Sky-high medical bills from doctors you never even considered could be out of your health care network because at the time of care, pain, not payment, dominated your concerns.

Lassoing those surprise fees is the driving force behind the bill some New Jersey Democrats have unveiled.

“Everyone deserves to make a good living but not to the extent that it hurts consumers in an unbalanced manner,” said Sen. Joseph Vitale.

“Pretty enthused about this bill. It does what we want it to do. It protects the consumer from surprise out-of-network charges,” said New Jersey Citizen Action Health Care Organizer India Hayes Larrier.

“We think there was an emerging consensus to deal with the problems that have been identified and I think there’s a public awareness and consensus that there are some issues that have to be addressed but this goes way past that,” said Mark Manigan, attorney for providers.

Horizon Blue Cross Blue Shield says last year it paid $1.2 billion in out-of-network charges and passed them on to consumers in premiums.

“We really don’t believe that the laws of New Jersey should permit price gauging,” said Horizon Blue Cross Blue Shield of New Jersey Executive Vice President Kevin Conlin.

The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act aims to cap prices, compare procedure costs in a database, give a month’s notice of who the provider is and the cost and cut surprises off at the knees so that out-of-network fees will be treated — and disputed in binding arbitration, if necessary — more like in-network rates.

But, the Medical Society of New Jersey says in no other industry does the service provider rely on a third party for payment, and then have to fight to receive it. To improve quality patient care and reduce costs, insurers must reduce administrative burdens and provide fair payments and contracts to physicians who dedicate their lives to serving the needs of their patients.

“I think what we should do is focus on the concept of bringing some rational process to where there is not one right now,” Manigan said.

“Should this work the way it’s supposed to work, no one should have an unfair advantage,” Larrier said. “That’s the a comfort to consumers. That’s the protection to consumers that we are looking for.”

“We’re going to be very active in leading some of those conversations and participating in others to ensure that we can achieve two goals: again eliminate surprise bill situations and also get the out-of-network cost out of the system so that we can reduce the total cost really for everyone,” Conlin said.

Whether this becomes law in New Jersey with this governor in office is the big question, but as one person said, just because you run into a roadblock doesn’t mean you don’t make the journey.