NJ lawmakers take aim at out-of-network health care costs

After working on it for years, New Jersey lawmakers finally introduced a bill Thursday that would limit how much out-of-network doctors and hospitals can charge for their services.

They cited reports of exorbitant and often unexpected bills that must be capped.

"You can't expect a patient who is lying on a hospital bed awaiting surgery to look up and ask whether or not their anesthesiologist is in their network," said state Sen. Joe Vitale (D-Woodbridge). "Patients should know that when they go to an in-network hospital with an in-network surgeon that all of the services that are provided for them should be in-network, but if they're not they should be protected from those costs."

The sponsors of the legislation said they expect staunch opposition from specialists and hospitals that might fear the bill could restrict their ability to turn a profit. A meeting with stakeholders has been scheduled for May 22.

"I think it is a monumental bill in New Jersey history. This bill finally takes issue with a huge issue that some believe could save consumers over 14 percent in health care costs," said Assembly Budget Committee chairman Gary Schaer (D-Passaic).

The measure would require hospitals and doctors to provide a patient with a written disclosure form that outlines the following information at least 30 days before a non-emergency or elective procedure:

•  Whether the health care facility or professional is in-network or out-of-network;
• That it is in-network, the patient will not have any out-of-pocket costs unless he or she has selected an out-of-network provider to provide services.

Prior to a procedure, doctors and hospitals would also be required to give the patient a description of the procedure, a reasonable estimate of the costs and information on all other expenses. The patient would be required to sign and return the form.

"Sometimes rather than just coming home with their beautiful new baby or to be able to focus and heal they (patients) are ending up getting a stack of bills from people that they're never spoken to, seen or heard of and it's unacceptable that we let this go on and on without doing anything about it," said Linda Schwimmer, New Jersey Health Care Quality Institute vice president.

The bill has been titled the "Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act." It also includes a binding arbitration process for certain emergency and out-of-network billing situations if a carrier and health care provider can't agree on a reimbursement rate.

The New Jersey Association of Health Plans cited several complaints about exorbitant bills in New Jersey. They included:

• A patient billed $86,846 for two cortisone shots;
• A patient billed over $14,000 for four stitches;
• A patient billed roughly $9,000 to treat a cut finger;
• $129,984 to treat a hip fracture;
• $36,000 to treat a migraine.