NJ Bills Look To Boost Health Care Cost Transparency

The New Jersey Assembly Financial Institutions and Insurance Committee is set to  a two-bill package aiming to eliminate what lawmakers call surprise out-of-network health care charges through enhanced transparency and consumer protections.

During its joint meeting today, Monday November 23, 2015, the New Jersey Assembly Financial Institutions and Insurance Committee will consider the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, spelled out in Bill A4444, and the New Jersey All-Payer Claims Database Act, summed up in A952.

Bill A4444 aims to increase transparency in health care services pricing, establish a system to resolve billing disputes and contain rising costs, according to the lawmakers. The database envisioned in Bill A952 would be housed within the Department of Banking and Insurance and would likewise boost transparency, as well help identify trends and help inform decisions and negotiations among consumers, providers and insurers, according to the bill’s statement.

“It is completely unreasonable and horribly unsafe to expect a patient lying on a hospital bed waiting to go into surgery to ask the anesthesiologist assigned to their care if they accept their insurance,” Sen. Joseph F. Vitale, D-Middlesex, one of A4444’s backers, said in a statement when the bill was introduced in May.

The bill’s other sponsors include Assemblymen Craig Coughlin, D-Middlesex, Gary S. Schaer, D-Passaic, and Troy Singleton, D-Burlington, as well as Assemblywomen L. Grace Spencer, D-Essex, and Pamela Lampitt, D-Camden.

Coughlin said at the time that the state’s insurance companies and providers had failed to negotiate good-faith contracts for far too long and used patients as their “bargaining chip” to maximize profits.

“This bill protects patients by taking them out of the fight and insulating them from balance billing while giving providers and insurance companies a path to compromise,” he said.

The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act would require health care facilities and professionals to provide patients with written disclosure forms no fewer than 30 days prior to nonemergency or elective procedure.

The forms would clarify if the facility or doctor is in or out of the patient’s health benefits plan network; that the patient won’t incur out-of-pocket costs unless that person has specifically opted for out-of-network services; and that the patient’s costs for an out-of-network provider would be applicable to services from an out-of-network facility or by an out-of-network professional, according to the bills statement.

The health care provider would also have to explain the procedure and provide other information in layman’s terms, as well as publish an online list of in-network providers to be updated every 20 days.

Under the bill, insurance companies would also be required to publish on their websites a list, to be updated at least every 20 days, of all in-network providers and disclose the list to covered persons upon plan enrollment or as requested.

In the event of medically necessary emergency care administered by an out-of-network provider, the patient’s cost wouldn’t exceed those of in-network providers under the bill. In that same scenario, an insurance company could not be billed more than 250 percent of the median paid in-network commercial claim for a service.

The bill also outlines a binding arbitration process in the event of a bill dispute involving certain emergency and out-of-network billing services, although arbitration wouldn’t be an option for covered patients who knowingly selected an out-of-network provider for services available through their in-network providers.

Bill A952 was introduced in January by Singleton and Assemblymen Jack M. Ciattarelli, R-Somerset, and Joseph A. Lagana, D-Bergen.

The database outlined in the legislation would process, analyze and report health care data collected from health care facilities, professionals, insurance carriers and multiple state health programs, according to the bill. It also establishes provisions regarding the reimbursement of out-of-network health care providers by insurers that offer managed care plans.