Surprise Billing for Out-Of-Network Medical Costs – Patient Protections on the Horizon

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

#PatientRights #PatientAdvocate #HealthInsurance

About Jacqueline O'Doherty

Jacqueline O'Doherty of Health Care Connect, LLC is an experienced certified Patient Advocate who guides patients through our complex, confusing and changing healthcare system. As a Patient Advocate, Jackie supports and empowers patients and their families, making sure the patient is aware of all the options available to them by researching illness and disease, coordinating patient care and facilitating communication and continuity among the healthcare providers. She also assists in obtaining physicians and homecare…nurses, home health aides, physical therapy etc, as well as researching and facilitating short and long term care options. Jacqueline navigates the healthcare system with patients and their families, throughout the medical continuum, ensuring-patient centered care and protecting the patient’s healthcare rights. Jacqueline also provides peace of mind for long-distance caregivers by coordinating and overseeing senior care. Health Care Connect furnishes “feet on the ground,” resolving long distance and “sandwich generation” care dilemmas. Jacqueline teaches patient empowerment seminars enabling participants to utilize the healthcare system with greater confidence and success. Jacqueline spent 18 years in the medical device industry calling on various hospital departments and physicians across the medical continuum, allowing her to understand firsthand the difficulties of navigating the healthcare system. Jacqueline is a graduate of the Alfus Patient Advocacy Program at the University of Miami. She is also a graduate of Towson University with a degree in psychology. Jacqueline is a contributor to Hospital Impact and runs her private practice from Califon, NJ Jacqueline also serves on the board of directors for ICOPPA…International Coalition of Professional Patient Advocates. For further information please contact Health Care Connect, LLC Phone: 908-832-0417 Email: Website:
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