Trenton, NJ – Members of the NJ for Health Care Coalition, a diverse collection of organizations which represent health care consumers, applauded the Assembly Financial Institutions and Insurance Committee for advancing a strong bill to protect consumers from Surprise Medical Bills. The bill passed by a majority vote.
Current state law protects consumers in fully insured plans from being held responsible for an out-of-network charge in an emergency situation. Bill A444, “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” expands that protection to include non-emergency situations when a consumer uses an in-network facility and is unknowingly treated by an out-of-network provider.
“This bill expands current protections for consumers who face surprise medical bills that are both unfair and create undue stress. It requires more disclosure and protections to ensure that consumers cannot be held responsible for out-of-network charges when they are not provided a choice for an in-network provider. It also requires a dispute resolution process that will protect consumers from unfair out-of-network bills and collection actions,” said Maura Collinsgru, Health Care Program Director for New Jersey Citizen Action.
“Medical debt is a leading cause of bankruptcy, and like expanding coverage for the uninsured, this reform is needed to ensure that consumers who do the responsible thing to gain or maintain coverage do not have their financial security threatened because they sought necessary medical treatment. We applaud and thank the sponsors, Assemblymen Coughlin, Schaer and Singleton, and Senators Vitale and Weinberg for their leadership, as well as the Committee for their majority vote.”
Consumers who have experienced the pain of these bills are pleased that these protections are being put into place. “I am very happy that the Assembly Committee has voted to move this legislation forward. There are so many more people who get caught in this trap than we even know about and it can ruin their credit and sometimes their lives,” said Arthur Lemise of North Arlington, NJ, who received a $5,200 surprise out-of-network bill from an Emergency Room visit. “We really need to be protected from these surprise medical bills. I only wish it was the law when I was faced with a surprise out of network provider.”
Under the bill, providers are required to make clear and timely disclosure to consumers about any out-of-network providers that might be part of their care, so informed and voluntary decisions can be made whether to use those providers or not. Diana Autin, Executive Co-Director of the Statewide Parent Advocacy Network, which serves many families with children with special needs, thinks this provision will especially help the consumers she sees. “Families with children who have special healthcare needs are always at risk for receiving high out-of-network bills because they have more contact with providers of all types,” she says. “The disclosure requirements here are crucial to parents who have limited resources and need enough information to make informed decisions about their children’s care. Overall, this bill helps protect those limited resources a little more carefully.”
The Out-of-network bill also gives protection to the 70% of consumers in New Jersey who are in large employer-sponsored, self-funded plans. These plans, established and regulated under the Federal Employee Retirement Income Security Act (ERISA), can “opt-in” to the new provisions the bill establishes, thus giving their members the same protections from surprise bills. And if a self-funded plan “opts-out”, the bill provides for an arbitration-like process that those members can access.
For those in fully insured plans and ERISA plans that opt-in, either a provider or insurer can initiate the arbitration process, where both parties bring their best offer to the negotiating table. The consumer is held harmless and is not involved in the dispute resolution. What’s more, providers must exhaust the arbitration process, and cannot put a consumer into collection until that process is completed – a provision applauded by Renee Steinhagen, Executive Director of NJ Appleseed Public Interest Law Center.
“The protections that this bill affords consumers are huge,” Steinhagen says. “The fact that providers cannot send consumers to collection until they exhaust the arbitration process is a significant victory for the individual whose self-funded plan does not opt-in the baseball arbitration procedure governing state regulated plans. Finally, New Jersey consumers will have a robust recourse mechanism when facing surprise medical bills.”
Consumers Union, the policy and advocacy arm of Consumer Reports, has seen similar legislation in other parts of the country and joins in commending the Assembly Committee for its Actions. “A4444 represents a giant leap forward for protecting consumers against surprise bills in emergency and non-emergency care,” said Charles Bell, programs director of Consumers Union. “These smart protections will help to greatly reduce the incidence of surprise bills, and create a clear, efficient path for quick resolution when they do occur. We applaud the bill sponsors and the committee for their leadership in reducing billing hassles and improving information for patients.”
The next step for the Out-of-network bill is a hearing before the New Jersey Senate Commerce Committee, after which it will be sent to the full Assembly and Senate for passage to Governor Chris Christie.
NJ For Health Care is a broad-based coalition of over 60 health care, consumer, senior, student, disability, women’s, labor, faith-based, civil rights and social justice organizations representing over 2 million members, working to bring guaranteed, high quality, affordable health care to all New Jersey residents.
New Jersey Citizen Action, convener of NJ for Health Care, is a statewide progressive advocacy fighting for social and economic justice. We put progressive values into action.