Newspaper article The Record (Bergen County, NJ)

Bill on Surprise Medical Fees Advances

Newspaper article The Record (Bergen County, NJ)

Bill on Surprise Medical Fees Advances

Article excerpt

After six months and several changes at the requests of a range of interest groups, a bill intended to protect consumers from exorbitant out-of-network health care costs has cleared an Assembly committee, putting it on a path toward Governor Christie's desk before the legislative session ends in January.

Despite the revisions, the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act still faces strong opposition from the health care and medical industry. The focus for most of the five hours of testimony in Trenton on Monday homed in on the fine points of the legislation and how hospitals and health care providers would be fairly compensated, not on how consumers would be shielded from crippling fees.

"We are here to take care of and provide the highest-quality care for the people in southern New Jersey. We obviously can do this only if we're fairly compensated," said Joseph Devine, president and CEO of Kennedy Health System. He added that the legislation "will usurp our authority to negotiate a fair and reasonable rate with insurers."

The bill approved by the Assembly Financial Institutions and Insurance Committee is a considerably different proposal than the one put forth earlier this year. Among the additions to the bill are a peer-review process for arbitration, modified disclosure requirements, requiring annual auditing of managed-care plans and requiring a study of the legislation's effect on health care in New Jersey. Lawmakers also took out a provision to establish a health care provider index, putting that in separate legislation that also was approved by the committee Monday.

For years lawmakers have tried to adequately address the high costs billed to patients who, unwittingly or in emergencies, use services outside their health care insurance network. Over the last two years a handful of lawmakers, including Assemblyman Gary Schaer of Passaic, have worked to develop a bill to limit those costs, increase trans-parency for health care billing and provide for a system of arbitration for billing disputes between providers and insurers.

The bill stalled over the summer for lack of support and amid pushback by the health care industry. In the months since, a task force was formed and met regularly, and lawmakers considered a series of revisions suggested by health care professionals. But the changes aren't satisfactory in their view.

'Not a fair fight'

"The in-network and out-of-network environment are both going to be worse," said Mishael Azam, chief operating officer for the Medical Society of New Jersey.

Opponents of the bill said that the arbitration system, known as baseball-style arbitration because each side makes an offer and a mediator chooses one, would favor insurance companies with much more time and resources to argue over disputed charges. …

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