MAJOR STEP FORWARD IN EFFORT TO END SURPRISE MEDICAL BILLS

A bill that will protect consumers from surprise medical bills took a crucial step toward passage on April 5 when it won narrow approval from the Senate Commerce Committee, by a 3-2 vote.

That same day, S-485/A-2039, also known as the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, also made it past the Senate Budget Committee (7-3) and the Assembly Appropriations Committee (7-2).

The Senate Commerce vote was regarded as the most uncertain of the three because earlier versions of the bill had stalled in that committee in the prior two legislative sessions.

The bill had already been reported out of the Assembly Financial Institutions and Insurance Committee on March 5, so it is now cleared for votes in both houses.

It is posted for an Assembly floor vote this coming Thursday, April 12, and it is hoped that when the list of bills is posted for the full Senate session that same day, it will also be listed there.

The legislation, most centrally, holds consumers harmless from having to pay more than the in-network rate when they receive services from an out-of-network health provider in an emergency situation or through inadvertence. For non-emergency care, consumers need not pay higher out-of-network rates unless they are informed in advance of the provider’s out-of-network status and what that provider will charge and they agree to those services and charges.

Not surprisingly, it has broad support, with backing from health care and consumer advocates, unions, health insurers, and business interests/employers.

And with some last-minute tweaks that were adopted by the Commerce Committee as part of its April 5 vote, it won support from hospital interests as well, leaving doctors, for the most part, as the interest group opposing the measure.

Those amendments: reduce the time for health insurers to deny claims from 30 days to 20 and for arbitrators to decide claim disputes from 45 days to 30; require insurers to make annual reports on claim denials and downcodes and the reasons for them and also on savings resulting from the bill; and forbid carriers from making an additional offer of payment after the arbitration submission.

Another amendment deleted the list of factors the arbitrators would have to consider in choosing between the two positions. Providers had objected that the factors included in-network, Medicare and Medicaid rates which which would result in too-low awards.

The voting was along party lines, with Senate Commerce chair Nellie Pou, and Assemblymen Joseph Cryan and Nicholas Scutari, all Democrats, voting “yes” and Republicans Gerald Cardinale and Thomas Kean casting the “no” votes.

New Jersey Appleseed which has long been involved in health care reform and is a founding member of the New Jersey Healthcare Coalition and was active in promoting the bill, gave testimony in support of it before the Commerce Committee.

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