To protect individuals from receiving bills for 'surprise' or 'unexpected' out-of-network medical expenses, legislation will continue in the year of early 2017 after going on pause earlier this month.
To approve legislation that would regulate and control out-of-network medical bills that New Jersey sufferers might surprisingly get; state lawmakers, consumer advocates, health insurers and health providers have been on an 8-year mission.
The Senate bill, sponsored by Sen. Joseph Vitale, was put on hold previous week when the Senate Budget Committee delayed its hearing because various stakeholders inquired for more time to analyze amendments and changes made merely days before the hearing.
“The priority of the bill is customers, and when all is said and done, they will be the ones who highly benefit from the legislation. It has taken years for involved parties to compromise on how to decrease balance billing, or additional medical billing, because the problem is so complicated”, Vitale said.
The charges of Out-of-network from doctors, hospitals, health care providers and gaps in insurance coverage have become a rising concern for sufferers. Supporters of the bill claimed that over 168,000 individuals every year are charged huge sums of money for unexpected medical bills.
In accordance to research from the New Jersey Policy Perspective, those charges have resulted in an extra $1 billion to 5 million privately-insured consumers of New Jersey in the form of higher premiums as an outcome of these out-of-network problems.
Maura Collinsgru, leader of New Jersey Citizen Action’s NJ For Health Care coalition, has represented consumer advocacy in bill discussions. She claimed that the primary concern of coalition, as aligned with the bill, is to fix an error in the healthcare system that disproportionately hurts consumers.
The representatives from other health care providers, hospitals, health insurance companies and consumer protection groups all accepted that the out-of-network billing practice is a major problem, but coming to a solution that benefits all stakeholders is more convenient said than done.
Kerry McKean Kelly, vice president of communications at New Jersey Hospital Association said, "You might write in a specific provision, but because it is so complicated, it can have unintended consequences or affects.”
The association represents several hospitals, health providers and experts who need to ensure that they are yet paid fairly for their work if out-of-network charges become the responsibility of the heath provider or insurance company.
In accordance to Kelly, a solution in both the Senate and Assembly versions of the bill is to pay hospitals and healthcare providers for this kind of billing utilizing reimbursement rates that MediCare uses. Health providers were previously concerned because MediCare rates are mostly below the cost of care.
Recently, the stakeholders sat down with Vitale and other legislators to come to an agreement on few of those problems, but discussion will have to continue into next year.
The legislation for Out-of-network would make New Jersey join various other states, involving New York and California, which have similar laws in order to secure consumers from getting billed for things like an unexpected medication or a consult from an out-of-network specialist during the surgery.
Health insurers have a stake in the legislation, too. Vitale claimed that health insurers need to make certain that they won’t be overpaying for out-of-network services.
Horizon Blue Cross Blue Shield New Jersey released in a statement, “Through their efforts, the sponsors are closer than ever to passing out-of-network reform legislation and we’re optimistic that they will acquire that aim to put an end to surprise medical billing and price gouging”.
For bill, the Senate hearing will likely take place in the month of January.