TRENTON, N.J. (CBSNewYork) — Lawmakers are looking to protect New Jersey residents from surprise medical bills.
CBS2’s Meg Baker explained, there’s a plan to help consumers who get his with unexpected charges after going to the emergency room.
John Peterson is a Little Egg Harbor resident, who says he started having hearing and balance issues in 2014.
“Called my insurance first, checked the doctor’s name, they said I was covered in network, called the doctor, yes we accept your medical card, saw the doctor, recommended an in-house balance test,” he said.
The balance test, conducted in the same building, with the same doctor, was considered an out-of-network test, so he got hit with an unexpected bill.
“Later I got the bill and it was for $1,600,” he said.
He testified in Trenton, Monday in support of the Out-Of-Network Consumer Protection Transparency, Cost Containment And Accountability Act.
“After you get hit by a bus is not the time to ask to be taken to an in-network hospital,” Assembly Speaker Craig Coughlin said.
The bill intends to eliminate surprise out-of-network health care charges when an individual received medically necessary emergency services or inadvertent out-of-network care.
On average, these visits resulted in a surprise bill of more than $600, but could cost as much as $19,600 extra.
“Health care is the only business where consumers have no idea what service will cost them until after provided,” Coughlin said.
Assembly Speaker Craig Coughlin said the legislation will insert transparency into the equation. Providers will be required to tell patients if a service is out0of-network, and an arbitrator will be assigned. Patients will no longer have to be the mediator between their doctor’s office and insurance company.
India Hayes with AARP New Jersey said consumers should be concerned with getting better, not how they are going to pay. This can be particularly crushing to older adults on a fixed income.
“It’s estimated 168,000 consumers in New Jersey will received these bills totaling $400-million. That’s just in New Jersey,” Hayes said.
Advocates for hospitals and physicians oppose the reform insisting it will undermine their negotiating power with insurance companies and drive providers out of New Jersey to less regulated states. A vote is not expected for weeks or months.