The Star-Ledger

Hospital Bill Isn't Protecting Patients, Group Says. It's Protecting Profits.

The Star-Ledger — June 17, 2019

By Maura Collinsgru
Star-Ledger Guest Columnist

New Jersey's State Legislature is fast-tracking a bill that claims to protect New Jersey health care patients. The legislators and hospitals behind S3816/A5369 contend there is a persistent problem with out-of-network bills for patients transferred or referred to out of state health care facilities or providers. But what the bill really seems to protect is the profits of some New Jersey hospitals against out of state competition.

New Jersey Citizen Action and our partners in the New Jersey For Healthcare Coalition spent four years fighting to pass the landmark Out of Network consumer protection law in 2018, which greatly expands patient protections against surprise out-of-network bills. But hospitals and providers were slow to sign on, and some never did. It came as a surprise to see how quickly a number of them rallied around a bill purporting to provide more protections against unexpected medical bills.

And no wonder. The bill adds no real value to out-of-network protections. Instead, it makes transferring to an out of state facility as complicated as buying a house.

Under this bill, hospitals and providers would have to - before transfer - have patients sign off on paperwork that includes: a statement of their rights to receive care at a facility they chose; the clinical basis for the transfer; the location of the out of state facility; reasons why they are not being transferred to an in-state facility; notification to the insurance carrier about the network status of the facility; estimated out-of-pocket costs the patient would incur; whether or not services are available in the state; and professional affiliations between the referring provider and out of state facility.

This dizzying array of paperwork would likely confuse any patient, much less one strapped to a hospital gurney in urgent need of treatment. And it could mislead patients about the scope of New Jersey's Out of Network law, which already provides protections to patients insured by a New Jersey regulated health plan (or self-insured plan that has opted in to New Jersey's regime) when they receive treatment in an emergency room or at an in-network facility, regardless of where that treatment takes place.

These patient protections do not necessarily stop at our borders. Patients are still protected from surprise medical bills when treated in Pennsylvania, Delaware, New York or elsewhere in the country for emergency treatment and for other treatment if the facility is in-network.

The reality is medical treatment in our country has become more integrated across state lines. Many New Jersey residents seek treatment from out of state hospitals and providers in surrounding states that are in-network with their New Jersey health plans. There might be a specific facility that best meets your medical needs in Philadelphia or New York City or some other out of state location. As a result, some New Jersey hospitals have partnered with out of state facilities and providers to further expand their network.

If state-regulated plans approved these dual-state partnership agreements and included out of state facilities in the plan's network, why then do we need to further regulate the choice of providers or patients to use their services? The answer seems to lie with the lobby for hospitals that don't have partnerships with out of state facilities, and don't want to lose their market share of patients to other states.

We can't limit where patients receive medical treatment. New Jersey residents should have no barriers to seeking treatment out of state, if that treatment works best for whatever medical issue or emergency they have. Our State Legislature should not let some hospitals put their profits over the needs of New Jersey patients, and should vote against S3816/A5369.

Maura Collinsgru is the health care program director for New Jersey Citizen Action.

Copyright 2019

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