Burlington County Times

Group Pushing For End To Surprise Medical Bills In NJ

Burlington County Times — May 29, 2017

By David Levinsky, staff writer

TRENTON — A coalition of health care, consumer and business advocates is pushing for state lawmakers to approve legislation to eliminate surprise out-of-network medical bills before they break for the summer.

The NJ for Health Care coalition argues that action on the issue is long overdue and will benefit consumers and businesses, as well as the state and local governments. Collectively, they are billed close to a $1 billion in additional costs because of out-of-network billing. The state could realize between $30 million and $140 million in savings.

"A dollar saved is a dollar saved. We do know it will generate savings," said Maura Collinsgru, health care program coordinator for the liberal group New Jersey Citizen Action, during a conference call Thursday with other coalition members.

The coalition, which also includes AARP New Jersey, the New Jersey Business and Industry Association and the Consumers Union, sent a letter to Senate Budget Chairman Paul Sarlo, D-36th of Wood-Ridge, urging him to schedule a committee hearing and vote on the legislation this week so it can be posted for a floor vote before July 1.

At issue is the alarmingly high out-of-network bills patients and insurers are charged by hospitals and doctors who don't participate in an insurer's network and won't accept an insurer's reimbursement as full payment. Patients are often billed the remainder of the fee, a practice known as balance billing.

In most cases, patients will go to an in-network hospital but can receive a large bill because a specialist, such as a radiologist or anesthesiologist, who assisted in their care was not part of their insurance network.

AARP New Jersey Associate State Director Jeff Abramo cited a case involving Lilyan Cralle, a volunteer advocate with the group, from Willingboro. Abramo said Cralle's husband recently underwent treatment for a neurological condition at an area hospital, but was examined briefly by an out-of-network cardiologist.

He ended up being billed over $1,000 for the examination, Abramo said.

Cases like that are becoming alarmingly frequent, advocates said. A report last year by left-leaning think tank New Jersey Policy Perspective estimated that about 168,000 state residents receive surprise bills each year for involuntary medical services.

"AARP believes consumers should be held harmless," Abramo said.

The issue is not a new one. In fact, legislation to try to address the practice has been kicked around Trenton for the better part of eight years. But crafting a legislative fix has taken on new urgency due to rapidly increasing health care costs.

Gov. Chris Christie is pushing for some action this year. His proposed budget for the upcoming fiscal year beginning in July relies on the state seeing $125 million in health care savings, and he has identified surprise medical bills as an area where those targeted savings might be found.

The governor has called for increased transparency about medical expenses and billing by requiring hospitals and doctors to disclose upfront to patients what their insurance coverage is and how much they will have to pay for treatment.

Consumer advocates like NJ Citizen Action support transparency but say that alone won't solve the problem. They want to make sure legislation addressing the issue also includes a binding arbitration process for cases in which insurance companies and health care providers are unable to agree on a reimbursement rate.

The groups favor "baseball-style" arbitration, which would require insurers and providers to submit their last, best offer for a review board to choose. Supporters argue that the method has worked in other states because it encourages both sides to negotiate a fair settlement to avoid arbitration.

Neil Eicher, vice president of government relations for the New Jersey Hospital Association, said the association is willing to support legislation that includes arbitration, provided it does not mandate a cap or set a range for settlements.

Doctors previously opposed that process, as well as proposed caps on reimbursements based on what Medicare pays, arguing that the Medicare reimbursement rates are generally less than their expenses and that the legislation would force them to join insurance networks or leave the state.

One possible compromise is requiring insurers to make interim payments to hospitals and other health care providers while a billing dispute is being resolved.

Collinsgru said the coalition supports that change, but insists that an arbitration process needs to be established for cases in which patients unknowingly or involuntarily receive care from an out-of-network doctor or hospital.

Some lawmakers have floated the idea of approving legislation that solely has a transparency component.

"Transparency only helps when consumers can make a choice. They don't help with emergencies or other emergent situations," Collinsgru said.

Eicher said the hospital association continues to meet with lawmakers to try to forge an appropriate compromise.

"We do want to get a bill through this year. That's our goal," he said. "We think we're very close to a solution, but there's still some minor but important details to be worked out."

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