N.J. Assembly panel OKs bill addressing out-of-network health care costs

Source: North Jersey.com
After six months and several changes at the request of a range of interest groups, a bill intended to protect consumers from exorbitant out-of-network health care costs 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 by the health care and medical industry. The focus for most of the five hours of testimony in Trenton on Monday, however, 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.
The bill approved by the Assembly Financial Institutions and Insurance Committee is a considerably different proposal 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, also approved by the committee.
The bill, introduced earlier this year, stalled over the summer for lack of support and 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.
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. They also said the threat of arbitration would force more doctors to go in-network, and they would lose their leverage in rate negotiations. Doctors and hospitals have complained that insurers arbitrarily set their out-of-network rates and pay less than the cost of care, either saddling providers with debt or forcing them to work for free.
It’s for those reasons that legislators added a peer review system for arbitration to try to ensure fairness, said Assemblyman Craig Coughlin, D-Middlesex, who has led the lower house proposal and chairs the insurance panel. While opponents say that would make the process costly and inefficient, Coughlin called the arbitration proposal overall “remarkably fair.”
The bill would also require health care facilities to publish contact information for physicians working at the facility and the hospital-based physician groups it has contracted for services. Health care professionals would also be required to disclose the benefits plans they participate in and the facilities they are affiliated with. If they don’t participate in a patient’s plan, the bill requires they notify the patient.
No one argued against those provisions on Monday. With the committee’s approval, the bill now heads to the full Assembly for a vote. A Senate version is pending.

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