Surprise Medical Bills: What they are and how to stop them

New Jersey’s leading consumer health coalition held a press conference today announcing the release of a new report, Surprise Medical Bills: what they are and how to stop them . The report examines the consequences and costs of these bills on New Jersey health care consumers and details the remedies necessary to fix the problem. and contains more than a dozen testimonials from consumers who have fallen victim to these out-of-network bills.

Health care consumer April Kuzas of Jersey City said, “I am astounded at the bills I received. It is unconscionable that hard-working consumers can be put in such financial jeopardy simply for needing medical care,”. These [providers] reap the benefits because there are not enough necessary safeguards for consumers.”

The New Jersey Legislature is currently considering S20/A4444 , a bill that includes many of the remedies – or safeguards – detailed in the report.

Maura Collinsgru, Health Care Program Director for New Jersey Citizen Action, convener of the Coalition stated, “This is a growing problem that continues to expand and affect more and more New Jersey consumers. It’s a statewide problem that demands a statewide solution. We need a health care system and solution that is transparent and fair and protects all consumers from these out-of-network surprise bills in the future.”

Report contributor, Renee Steinhagen, Director of New Jersey Appleseed Public Interest Law Center continued, “As the report details, this problem is incredibly urgent. Consumers falling victim to this practice are struggling with medical debt, and the practice is a major driver of increased health care costs for everyone in our state. We need the state to adopt a comprehensive and strong solution, and without delay.”

New Jersey is one of a handful of states that have taken up the problem. Illinois and New York have recently passed legislation. Consumer Union, a national independent organization that works to ensure fairness and safety in the marketplace and empower consumers to protect themselves, has partnered with the Coalition in hopes of making New Jersey the third (? Is this correct) state to pass legislation to protect consumers from this growing problem.

Arthur Church, of North Arlington, agrees with April. “Too many providers treat patients in in-network hospitals even though they themselves won’t accept any – I mean any – insurance plans. It leaves the patient with thousands of dollars in bills, and it’s really not fair to the consumer,” he said, “New Jersey should do a better job of keeping us out of the middle.”

Chuck Bell, Program Director for Consumer Union stated, “The New Jersey Legislature has the power to stop this unfair practice in its tracks. The bill now advancing in the Legislature would go a long way toward fixing this problem, but not if the special interests have their way. The physician associations and hospital systems who oppose this bill want to protect their right to continue bloated billing practices – even price gouging. These hidden practicesare harming consumers. New Jersey needs to adopt protections that do away with surprise medical bills once and for all and reign in the excesses of out of network billing in general.”

Teri Vetter of Howell received one such surprise bill when she went into the hospital for surgery. “I went into an in-network hospital for surgery performed by an in-network surgeon. Unfortunately, that surgeon used an assistant surgeon – without my knowing it – who was out-of-network. Imagine my surprise, a few months later, when I received a $4,200 bill for a doctor I had never asked for, didn’t know about and never even met.”

Consumer advocates support S20 / A4444. The bill, sponsored by Asm. Coughlin, Schaer, Singleton and Senator Vitale, is currently in Senate Commerce Committee and Assembly Financial Institutions Committee awaiting action. The bill would protect all consumers from surprise bills, including those enrolled in self-insured plans. To protect the NJhealth care market from increased prices in general, the bill establishes arbitration to tamp down on excessive out of network bills that are in dispute between insurers and providers. It would also require annual audits of health plan networks to ensure they are in compliance with adequacy standards and calls for establishing a Health Care Price Index (HPI) a database of reimbursed health care charges. This information, currently known only to insurers, will bring much needed transparency to health insurance payments, and will make available to researchers, policy makers and consumers the information needed to examine health care trends and instruct future health cost and policy decisions..

In support of establishing the HPI, John Sarno, President of the Employer Association of New Jersey, representing small employers stated, “[It is important to] establish a Healthcare Price Index (HPI). Doing so will increase transparency in health care cost and utilization patterns and provide all health care stakeholders with the information we need to support necessary health care reforms that will lead to a more cost-effective, high-quality health care system that benefits all citizens of this State.”

If quality, cost effective and affordable health care is the goal, the NJ for Health Care coalition believes that consumer protections that work must be implemented.

This project is a collaboration between: