Democratic U.S. Sen. Bob Menendez joined patients and consumer advocates at New Jersey Citizen Action headquarters in Newark on Friday to announce bipartisan legislation aimed at protecting patients from surprise, unanticipated medical bills that too often can lead to a patient’s financial ruin.
These costly bills frequently occur when a patient receives emergency care from an out-of-network hospital, or is treated at an in-network facility only to find out later that one or more of their treating providers fall outside their insurance network.
“Health care coverage is supposed to protect you from financial ruin in the event of an illness or injury. Unfortunately, it doesn’t always work out that way. Every year, millions of Americans who think they have great coverage still get whacked with huge and totally unexpected medical bills,” said Menendez. “It’s time for Congress to take action, and that’s why I recently joined a bipartisan group of my Senate colleagues as a sponsor of the STOP Surprise Medical Bills Act.”
According to a 2016 New Jersey Policy Perspective report, some 168,000 patients in the state received a surprise bill from an out-of-network provider costing them a combined $420 million a year.
The STOP Surprise Medical Bills Act closes that gap by prohibiting three scenarios in which surprise medical billing (also known as “balance billing”) commonly occurs:
- Emergency services: The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
- Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
- Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider’s office but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.
This bill assures the patient is only billed the in-network rate and completely removes them from any further billing fight between their health care provider and insurer. It allows medical providers to be automatically paid the difference between the patient’s in-network cost-sharing amount and the median in-network rate for these services.
Providers and insurance companies would then have the opportunity to appeal this payment amount through an independent dispute resolution process and arbiter certified by the Secretaries of Health and Human Services and the Department of Labor. The independent arbiter’s decision would be based on commercially-reasonable rates for that geographic area and be binding.
“No family in America should have to file for bankruptcy just because they had surgery or were sent to the emergency room,” said state Sen. Joe Vitale, D-19th District, author of the state bill. “Sen. Menendez has been a great partner in Washington. I thank him for his influential leadership and fierce advocacy on behalf of all of New Jerseyans.”
“Surprise medical billing is irresponsible and victimizes hundreds of thousands of patients and their families every year,” said NJCA Executive Director Phyllis Salowe-Kaye. “NJCA helped lead the fight to pass state legislation to protect NJ patients against surprise bills. But we need The STOP Surprise Medical Bills Act to finally put an end to this egregious practice and ensure all Americans across the country are protected. NJCA has long supported and protected the rights of consumers across the state and we appreciate having Sen. Menendez as a partner in this important work,” Salowe-Kaye said.