N.J. Medical-Bill Reform Stalls

The Record ( — Wednesday, June 10, 2015

Staff Writer
The Record

A measure meant to protect patients from surprise medical bills and rein in exorbitant charges to insurance companies has suffered a significant setback, and its sponsors said Wednesday they will regroup amid strenuous opposition from physicians and some hospitals, including a Hudson County chain whose bills are among the nation's highest.

The measure foundered earlier this week in the Senate Commerce Committee, when it became clear that it didn't have the votes to move it forward. As a result, the bill could not advance to the Senate Budget Committee and the full Senate.

State Sen. Joseph Vitale, the Middlesex Democrat who heads the Senate Health Committee and is the measure's prime sponsor, expressed his disappointment, saying that opponents who testified against the bill had been motivated by "personal and corporate greed," while "consumers were left out of the equation."

As long as action on the measure is delayed, he said, "health care consumers are getting gouged and ripped off at every turn. Who speaks for them? I thought it was the Legislature."

A decision is expected today on whether the Assembly committee that oversees insurance will be allowed to vote on the measure on Monday. No additional hearings in either house have yet been scheduled, though Vitale said work will continue over the summer and he hopes for action in the fall.

The bill is meant to shield patients when they seek care in an emergency at a hospital that is not part of their insurance network. Patients could not be billed more than they would have been if they had gone to an in-network facility. It also would protect patients from out-of-network charges by hospital-based physicians, such as anesthesiologists and neonatologists, when the patient is at an in-network hospital.

One Franklin Lakes family, for example, was sued this year by a collection agency for the amount owed on an out-of-network bill from an anesthesiologist who assisted in an emergency C-section at The Valley Hospital in Ridgewood.


For insurance companies, who often are liable for the excess charges when a patient receives out-of-network care, the measure would establish an arbitration system to settle disputes over the appropriate reimbursement.

Hospitals have said the measure would "upset the health-care economy" in New Jersey and reduce their leverage with insurance companies. The CarePoint Health system in Hudson County said that its three for-profit hospitals rely for their survival upon high out-of-network charges to the small fraction of its patients who have private insurance, and might close. And doctors say the bill's provisions would encourage insurance companies to underpay them, leading to expensive arbitration proceedings.

Assemblyman Gary Schaer, the Passaic Democrat who heads the Assembly Budget Committee and is a prime sponsor of the bill, said, "We learned that there is some significant misinformation out there. ... We need to do a better job in clarifying what the bill actually says."

"I'm confident that the bill will get done," Schaer said. "If it takes an extra month or two or even three ... I'm hopeful it will get done by the end of year."

'The fight continues'

Some consumer groups struck a hopeful note.

"This bill has unprecedented support from a variety of stakeholders," said Maura Collinsgru, of New Jersey Citizen Action, ticking off a list that included the AARP, labor unions, business associations, the Barnabas Health system of hospitals, and insurance plans. "It is not dead for the summer." Her group is mobilizing to speak to members of each legislative committee that will consider it, she said.

"It's time," she said. "Consumers don't need to wait anymore to have it fixed."

At AARP, advocate Ev Liebman said the group was disappointed in this week's lack of action. "Stalling is not the answer here," she said. "Consumers have been left holding this bag for far too long. There was a lot of work done on this legislation, and it's time to move it."

Perhaps most disappointed was Assemblyman Craig Coughlin, chairman of the Assembly committee overseeing insurance, who has convened more than 20 hours of hearings on the subject and is an Assembly sponsor.

"I respect the fact it touches on people's livelihood," he said. "We're always asked to do a balancing act."

But "the fight continues," he said. "We'll make it better if we can. I still remain confident that we will get something done, but it looks like it's going to take longer than I would have hoped."

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