MURPHY SIGNS LAW TO END SURPRISE MEDICAL BILLS

Governor Phil Murphy today signed into law landmark legislation that will help keep health care affordable for New Jersey residents by protecting them from surprise medical bills for out-of-network health care.

At least with state-regulated health insurance  plans covered by the plan, consumers will no longer have to pay any more than they would for in-network care unless they are informed of those added costs in advance and consent to pay them.  And added out-of-network charges could never be imposed for receiving needed medical care in an emergency situation. Consumers would remain free to obtain care from out-of-network providers but those bills would no longer come as a surprise.

Other insurance plans that fall under federal law and are thus not subject to regulation by the state, will be able to opt into the law, which takes effect 90 days from today.

The legislation, A-2039, is known as the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, and the name aptly describes what it does.

For more detail, read my earlier blog posts.  HERE and HERE.

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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.

Continue reading MAJOR STEP FORWARD IN EFFORT TO END SURPRISE MEDICAL BILLS

TIME TO PROTECT CONSUMERS FROM SURPRISE MEDICAL BILLS

For almost 10 years now, New Jersey lawmakers have been grappling with the issue of what to do about surprise medical bills.

They are the invoices sent by doctors and other health care providers who are not part of your insurance company’s network. So when your insurance does not cover the full amount of what they charge for their services, they come after you to pay the difference. Hence the term “balance billing.”

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A Healthcare Coalition

By Renee Steinhagen

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NJ Appleseed’s Role in the New Jersey and Greater Newark Coalitions

Since our inception, NJ Appleseed has focused its efforts on health care issues, providing a legal voice to communities and organizations seeking to establish health care as a social right by preserving hospitals as charitable community assets, improving access to quality, affordable health care services, and diminishing racial disparities in the health status of Newark residents. Our work in this area can be characterized as three distinct projects: The Community Health Assets Protection Project (representing the community in administrative and court procedures to ensure that hospital boards satisfy their fiduciary duties to the public when seeking to merge or sell their charitable health assets to a for-profit entity or another nonprofit with a different mission); a Consumer Advocacy Project and a Transforming Healthcare Delivery Project.

Under the rubric of our Consumer Advocacy Project, NJ Appleseed has participated on the leadership team of the NJ Healthcare Coalition since its founding in 2006. As the only legal organization participating in the Coalition (Legal Services of NJ informally participates but is not a member), NJ Appleseed services the Coalition, its individual members and the public generally with respect to legal policy issues, including drafting and analyzing legislation, preparing regulatory comments, and preparing white papers and consumer manuals with respect to legal rights, such as the right to appeal insurance denials of benefits. We are now considering whether to convert the New Jersey Sentinel website (which was product of a joint project between NJ Appleseed and Seton Hall Law School, funded by RWJ Foundation to evaluate essential benefits) into a comprehensive consumer health care website that provides information directly to New Jersey consumers on how to navigate the insurance, health care (providers), and public health systems in the State, and perhaps the website could deal with occupational health and safety as well as environmental health issues.

Since the closure of St. James and Columbus hospitals in Newark, NJ Appleseed’s Executive Director has been a board member of the Greater Newark Healthcare Coalition (consisting of a wide array of providers, including hospitals, physicians, federally qualified health centers, nurses, etc.), which was established as the Hospital CEO Working Group as a result of those closures. The Coalition is a planning organization that oversees various projects that seek to transform the healthcare system so it is more equitable, socially and racially just, and effective in improving the health status of Newark residents. NJ Appleseed is the Chair of the Legal and Advocacy Subcommittee, which is the one Board committee that draws mainly from persons who are not represented on the board. As one of three non providers on the board –- representatives from NJIT and Seton Hall Law School are the other two –- NJ Appleseed is trying to bring the consumer perspective to the Board’s decision making, and to encourage community participation in the organization’s activities.

We are seeking resources to support our activities in these two coalitions.

Advisors

CHRIST CHRISTIE URGED TO PROTECT HEALTH CARE

An op-ed piece by Raymond Castro, a senior policy analyst with NJ Policy Perspective, explains why Governor Chris Christie should speak out against repeal of the Affordable Care Act.

Christie’s “most important legacy as Governor” was taking advantage of the ACA to expand Medicaid to cover more than half a million low-income New Jerseyans, but that legacy would be lost with repeal.

Further, repeal would undermine the major behavioral-health and substance-use disorder initiative Christie announced at his State of the State address on January 13, which relies on Medicaid funding.

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NJ LEGISLATURE CALLS ON CONGRESS TO PRESERVE THE AFFORDABLE CARE ACT

Despite the human and fiscal harm that would result from repeal, Republicans have pronounced it a priority and on January 4, the Senate took an initial step toward that goal, approving a budget resolution that would clear the way for such legislation. The House is expected to follow suit next week.

In its last frenzied voting session before the end-of-year break, the New Jersey Legislature passed a resolution that calls on Congress not to repeal the Affordable Care Act, or ACA, also commonly referred to as Obamacare. The complete text of Assembly Concurrent Resolution 222 can be found here.

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LEGISLATION TARGETS $1 BILLION SURPRISE MEDICAL BILL PROBLEM

Surprise medical bills for out-of-network health care cost New Jersey residents nearly $1 billion per year, according to a report released last June by New Jersey Policy Perspective.

An estimated 168,000 people in the state receive out-of-network (OON) bills totaling $420 million per year but the actual cost is much higher because OON charges drive up the cost of the health insurance premiums paid by roughly 5 million New Jerseyans, for an estimated total cost of $956 million.

Continue reading LEGISLATION TARGETS $1 BILLION SURPRISE MEDICAL BILL PROBLEM