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

The out-of-network reform bill under consideration today deserves legislators’ support because it changes 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.

A-2039 (Coughlin, D-19; Schaer, D-36) is scheduled for a vote in the Assembly Appropriations Committee, and S-485 (Vitale, D-19; Weinberg, D-37) on the agenda of both the Senate Commerce Committee and the Senate Budget & Appropriations Committee.

“This is an extremely difficult and complicated issue, and we commend the bill sponsors for their hard work to make sure all stakeholders’ interests were considered,” said Mary Beaumont, NJBIA’s vice president of Health Affairs. “NJBIA believes the result is a good one and deserves the support of the committee.

“This bill strikes a fair balance between providing reasonable compensation to facility-based providers while protecting consumers from unexpected, non-negotiable bills that drive health insurance premiums higher,” 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 for their employees.

“Out-of-network costs play an increasingly significant role in the rising cost of healthcare for both large and small employers in New Jersey, triggering both higher premiums and out-of- pocket expenses,” Beaumont said. “Some employers fear that their next health benefits renewal will force them to drop coverage because the rate increase will be more than they can cope with.”

The key provisions of S-485/A-2039 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.