A coalition of consumer health groups gave its support Wednesday to proposed New Jersey legislation to rein in surprise medical bills for consumers who inadvertently use out-of-network health care providers.
The NJ for Health Care coalition released a report about the impact of such unexpected bills on patients who receive care from physicians outside their insurance plan, even when they seek care at in-network hospitals. The report cited 19 examples from patients.
"It seems like there's always a trick or a trap door or a physician you didn't expect to see sending you a bill." said Chuck Bell, program manager of Consumers Union in New York, a state which passed consumer-protection legislation a year ago. "We want a new set of ground rules that would create a fairer marketplace."
The group endorsed legislation sponsored by Assemblymen Craig Coughlin, a Woodbridge Democrat who heads the committee in charge of insurance; Gary Schaer of Passaic, the Budget Committee chairman; and Troy Singleton of Mount Laurel, along with state Sen. Joseph Vitale, D-Middlesex. The measure failed to make it out of committee in the spring, but the sponsors have vowed to push it forward this fall.
It would bar out-of-network physicians and hospitals from billing patients for more than their standard deductible and copayments when they receive care in an emergency, and require binding arbitration to settle disputes over the bills sent to health insurers. It also calls for creation of a state health care price index, a database of the price paid for in-network claims.
Doctors and some hospitals oppose the measure because it puts too much power in the hands of insurers, they say. The only way they can make up for inadequate reimbursement from government programs such as Medicare and Medicaid, they say, is by charging out-of-network patients more.
But "too often these bills are being presented to consumers and they are on the hook and held responsible for situations and bills they had no choice or control in making," said Maura Collinsgru of Citizen Action, who convened a conference call to discuss the report. "What we're asking for is a really a comprehensive solution."
She acknowledged that reimbursements to doctors and providers must be reasonable, so that they do not refuse to care for patients.
Teri Vetter, a resident of Howell, described on the call how she went to an in-network hospital for elective surgery in February. She had carefully checked to make sure her hospital, surgeon, and anesthesiologist were part of her insurance plan. But unbeknown to her, an assisting surgeon - whom she never met and whom her doctor never mentioned - was present in the operating room. Three months after the surgery, she received a bill for $4,200 from that doctor.
Out-of-network bills affect not only the patients who receive them, but add to insurance premium costs for everyone. "This practice is a major driver of increased health care costs for everyone in our state," said Renee Steinhagen, director of the New Jersey Appleseed Public Interest Law Center, who helped write the report.