MAY 13, 2015, 8:18 PM LAST UPDATED: WEDNESDAY, MAY 13, 2015, 8:24 PM
BY LINDY WASHBURN
STAFF WRITER |
THE RECORD
Consumers would be protected from surprise medical bills when they go to the hospital under a measure to be unveiled Thursday in Trenton by a group of powerful Democratic lawmakers.
Out-of-network charges to insurers would be capped. And in an unprecedented push for transparency, the state would publish a list of the average prices for almost every service, based on data the insurers would be required to submit. When hospitals or doctors and insurers disagree on the appropriate amount for an out-of-network bill, the measure calls for “baseball arbitration” — a state-appointed arbitrator to choose one side’s final offer.
The financial stakes are enormous, and a high-powered offensive from those whose revenues or income would be diminished by the measure is expected, including specialist physicians and hospitals.
“I think it’s going to be a fight,” for passage, said Assemblyman Gary S. Schaer, a Passaic Democrat who chairs the Assembly Budget committee and helped draft the “The Out-of Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” to be introduced today at a noon news conference.
But he pointed to the high-ranking Democrats who drafted the legislation, including state Sen. Joseph Vitale, chairman of the Senate Health Committee, and Assemblyman Craig Coughlin, chairman of the Assembly committee in charge of health insurance, both Wood-bridge Democrats — as well as Assemblyman Troy Singleton of Mount Laurel. Schaer is chairman of the Assembly Budget Committee.
Most lawmakers are expected to agree, he said, that “significant remedial action needs to be undertaken to tackle this issue, which contributes a lot to the rise in health-care costs,” as well as bankruptcies among state residents.
An important way insurance companies control costs is by negotiating contracts with hospitals, doctors, and other health-care providers who agree to accept their reimbursement and become part of their network. Some health plans include coverage for care received from providers who are not part of the insurer’s network.
The out-of-network charges billed by some New Jersey hospitals are among the highest in the country, and insurers say that they drive up premiums for everyone. In addition, patients who receive care from hospital-based physicians – over whom they have no choice – often are surprised to learn that they were out-of-network providers and charge much more than expected.