Bill Would Combat Surprise Out-Of-Network Medical Bills

Feb 5, 2018

Assembly Speaker Craig Coughlin testifies at legislative hearing.

A measure New Jersey lawmakers are considering is intended to eliminate surprise out-of-network medical bills.

The legislation requires health care facilities and professionals to disclose whether their services are covered by a patient's health benefits plan.

Assembly Speaker Craig Coughlin says it puts limits on out-of-network charges for medically-necessary emergency care and services ordered by an in-network provider but not available at that facility.

"Think about the scared 85-year-old who is facing potentially life-threatening conditions and now has to decide when they get a bill from a collection agency whether they're supposed to do it or not. We can eliminate that."

India Hayes Larrier with AARP New Jersey says an estimated 168,000 residents in the Garden State get unexpected out-of-network bills that add up to more than $400 million a year.

"Getting those bills impedes the recovery of patients and their families when really they should only be concerned with getting better."

Dr. John Poole is the president-elect of the Medical Society of New Jersey and a surgeon in Bergen County.  He says he wants to deliver the best health care he can at a lower cost, but he doesn’t believe the legislation would accomplish that. 

“My fear as a practicing physician is that right now the only threat that we have to negotiate with the insurance companies is to go out of network.  and if this bill passes in its present form, the insurance companies will be able to dictate what they want to pay for out-of-network care.”

The legislation would establish an arbitration system to resolve out-of-network billing disputes between providers and insurance carriers.