Out-of-network Health Insurance Bill Provides Fair and Balanced Solution

Legislators should approve A-2039 because it offers the best chance to change how out-of-network medical services are billed in a way that’s fair to both healthcare consumers and providers, the New Jersey Business & Industry Association (NJBIA) said today.

“Consumers who ‘follow the rules’ by using in-network healthcare providers and facilities should not be hit with surprise medical bills from out-of-network providers,” NJBIA Vice President Mary Beaumont said. “At the same time, providers need to be compensated fairly for their services.

“This bill strikes a fair balance between providing reasonable compensation to facility-based providers while protecting consumers from unexpected, nonnegotiable bills that drive health insurance premiums higher,” Beaumont said. She is testifying in favor of A-2039 (Coughlin, D-19; Schaer, D-36) before the Assembly Financial Institutions and Insurance Committee today.

“This legislation is necessary not only for employers, employees and all consumers, but also for the State of New Jersey to realize savings in the public employee health benefits plans. It’s been estimated that statewide out-of-network costs exceed $1 billion annually. Ultimately, these costs impact every taxpayer in New Jersey,” Beaumont said.

Out-of-network reform is necessary to protect consumers and help control the costs of healthcare insurance in general. Those costs have risen to an average of almost $22,000 a year for family coverage and threaten the ability of employers to continue to provide quality health benefits to their employees.

The bill’s key provisions involve transparency on out-of-network fees and fair resolution of disputed charges.

The “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” would ensure consumers receive advance notice if a provider is out-of-network, including disclosures by providers and facilities about network status, potential financial responsibility, description of the services and an estimate of the cost.

The bill also would limit what consumers would have to pay out-of-network providers in some cases and create an arbitration system to resolve healthcare billing disputes when the insurance carrier and provider cannot come to a negotiated agreement.