Coalition hopes to increase health care transparency through legislation

As the New Jersey Legislature considers regulating “out-of-network” health care — the high, surprise medical bills that can result when patients get care from doctors and hospital who aren’t in their insurance plan network — several health care stakeholders Tuesday announced a new coalition to advocate for legislation…The members of new coalition, NJ Healthcare Users for Reform and Transparency, or NJHURT, include representatives of health insurers, labor, consumers and public policy group.  

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The Assembly Insurance and Financial Institutions Committee chair, Assemblyman Craig J. Coughlin (D-Woodbridge), held two hearings in October on the issue of excessive out-of-network medical bills. The hearings were aimed at gathering stakeholder input for a possible legislative remedy to the out-of-network issue. Coughlin has not yet introduced an out-of-network bill.

Members of the coalition include the New Jersey Association of Health Plans, the trade group for the state’s health plans; The New Jersey Carpenters Funds; Plumbers and Pipefitters Local 322; and the Trenton public policy groups Common Sense Institute of New Jersey and New Jersey Policy Perspective.

The coalition said it has four goals:

• Increase transparency. Require hospitals and physicians to provide, for a significant number of the most commonly performed procedures, information about the fees they charge and make that information available in a user-friendly, online format.
• Reduce surprises. Hospitals should require physicians practicing at their facility to participate in the same insurance networks they do.
• Create a fair, simple arbitration process to resolve billing disputes. Each side submits a “best and final” offer; the arbitrator selects one within 30 days, and the loser pays the costs of the arbitration.
• Establish a reasonable fee schedule. This would cover out-of-network ER services based on actual costs.

“A true marketplace doesn’t work without transparency,” said Jerry Cantrell, president of the Common Sense Institute of N.J. “Right now, the deck is stacked against consumers. Health care might be the only place where you don’t get to know what something costs until after you’ve made the purchase. That has to change.”

“A trip to the emergency room shouldn’t come with a trip to bankruptcy court,” said Ray Castro, senior policy analyst for N.J. Policy Perspective. “Who, in the midst of a medical emergency, thinks about whether the hospital is in-network or out-of-network? In an emergency, every hospital should be treated fairly, and so should every patient.”

Jack Sullivan, health benefits manager for the New Jersey Carpenters Funds said, “We should establish a reasonable fee schedule for out-of-network ER services based on actual costs or a reasonable calculation.”

The coalition has launched a website, www.njhurt.org, that it said will seek to engage and mobilize consumers in the effort and provide them a forum to share their health care bill stories.

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