In January of this year New Jersey joined the 22 states that are working to prevent surprise bills to patients. The “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act”, presented to the New Jersey State Assembly addresses the long-standing issue that has been garnering attention for the past several years. In short, its intent is to protect consumers from the out-of-network costs that insurers routinely charge patients. Though not entirely comprehensive, it makes a path to alleviate the burden on the patient, especially in emergency care situations where care decisions take precedent over choice.
Naturally, patient advocates support this act which ultimately provides for transparency and accountability for all parties. The hope is that out-of-network costs would no longer cause financial ruin for the patient, who in good faith has a health insurance plan.
The safety net that health insurance provides is completely negated when the companies are eager to deny payment, causing the patient high out-of-pocket expenses. Primarily in emergency situations, patients are not in the condition to assess the insurance status of the care they’re being given. Also, the direct care providers do not take it into consideration either while caring for a patient.
In addition to emergency care, there are many involuntary scenarios that arise where a patient may be in an in-network facility but care is provided by an out-of-network physician. One example is a necessary surgery where the hospital and attending physician are in-network, but the anesthesiologist provided is not. The surprise bill would be financially devastating to most patients.
Most notably, the measure also protects patients from collection agencies and catastrophic financial outcomes while the disputes between the provider and insurance company are being resolved.
With a broad base of support from AARP, the New Jersey Business & Industry Association and public and private unions there are still detractors that doubt the mediation process proposed and the historically low re-imbursement formula provided by Medicare. But they concur the sound reasoning and process of the bill.
Since initially conceived eight years ago and officially introduced in June of 2015, the bill is currently in the State and Assembly Appropriations Committees awaiting a call to a vote in legislative session.
Eliminating surprise billing will be a major milestone for patient rights, as we work ever closer to an equitable single-payer care system.
Contact Jackie O’Doherty at 908-832-0417 or visit http://myhealthcareconnect.com.
#PatientRights #PatientAdvocate #HealthInsurance