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No More Surprises – NJ Surprise Medical Bill Law

New Jersey Governor Phil Murphy (D) signs law to take in effect within 3 months that will reduce Surprise Out-Of-Network Medical Bills.This is well needed and in-step with NYS law passed 3 years ago – No More Surprises – NY Surprise Medical Bill Law.

The reform is designed to protect patients, businesses, and others who pay for medical care from the high-cost bills associated with emergency or unintentional care from doctors or other providers who are not part of their insurance network. The law requires greater disclosure from both insurance companies and providers — so patients are clear on what their plan covers — ensures patients aren’t responsible for excess costs, and establishes an arbitration process to resolve payment disputes between providers and insurers, a mechanism intended to better control costs.

The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012).  According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem.  Officials say that this is now  “an overwhelming amount of consumer complaints.”   Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.”  Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.

The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices.  The NY Dept of Financial services  is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”

The Solution:  The The out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act requires greater disclosure from both insurance companies and providers — so patients are clear on what their plan covers — ensures patients aren’t responsible for excess costs, and establishes an arbitration process to resolve payment disputes between providers and insurers, a mechanism intended to better control costs.  The law sets a timeline and other parameters for negotiations between the payer and the provider and, if they can’t resolve the issue, requires the state to hire an independent expert to decide between the final offers presented by both sides. While earlier drafts of the bill included a range of factors for the arbitrator to consider in making this decision — including the doctor’s experience, the patient’s condition, and certain payment benchmarks — these details were eliminated entirely in the final version.

NJ becomes the 7th State to enact such consumer protection.  The other states include California, Connecticut, Florida, Illinois, Maryland and New York.

Learn how a Private Exchange and our PEO Partnership can help your group please contact us – info@medicalsolutionscorp.com or (855)667-4621.

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