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Out of network dispute to return Coughlin says he’s ready to unveil revamped bill

It was the health care issue that dominated the state with its various doomsday scenarios before the release of Horizon’s OMNIA Health Alliance took over that role a few weeks ago.

The health care issue that was a make-or-break for the future of for-profit hospital systems such as CarePoint, before its always quotable CEO Dennis Kelly resigned to move out of state.

The health care issue that ruled the state back in the time Donald Trump was polling just a few points ahead of Gov. Chris Christie.

It’s hard to believe this was just five months ago. But it’s been top of mind for Assemblyman Craig Coughlin (D-Woodbridge), who has been tweaking the bill he helped introduce May 14.

The bill’s latest version, set to be unveiled after the Nov. 3 elections, includes several updates — some, Coughlin said, come courtesy of the OMNIA announcement.

“The OMNIA plan has made it more challenging,” Coughlin said. “Some of the stakeholders who are uncertain, particularly hospitals, are slower to come around to the notion of accepting the bill because of the uncertainty of the OMNIA plan’s impact on them.”

But behind-the-scenes work continues on the bill as stakeholders discuss the various parts of the bill.

For instance, the latest version of the legislation does not have any caps on how much a health care facility can bill a patient or an insurance carrier for out-of-network urgent or emergency care. Instead, lawmakers are looking at arbitration as a method of dealing with the surprise exorbitant medical bills that patients get from out-of-network providers.

Those are the types of issues lawmakers and stakeholders hope to tackle by the end of the year.

“We are working, or have worked throughout the summer, with stakeholders, so I think it is still a front-burner item and it’s important to keep it there because we do want to try and get something done in this term,” Coughlin told NJBIZ. “The successes are that we have crafted a bill that is going to be able to achieve bipartisan support that protects consumers.

“Probably the other way around, it will get bipartisan support because it protects consumers.”

But there are still challenges, such as opposition or concerns coming from medical societies and the state’s hospital association.

Though the OMNIA issue has been demanding the attention of both the New Jersey Hospital Association and Medical Society of New Jersey, they have been very involved in the progress of the out-of-network bill’s language.

The NJHA has had a task force of more than a dozen individuals representing interests of hospitals in all sectors and sections of the state, which has met with the lawmakers at least five times over the summer, said Kerry McKean Kelly, spokeswoman for the NJHA.

Though there is consensus regarding transparency and consumer information, the arbitration process is still being discussed.

The MSNJ believes the OMNIA issue and the out-of-network issue are intertwined.

President Larry Downs said the focus of the out-of-network “surprise bills” has been the doctors, when in reality the focus should be equally shared with the insurance companies.

What OMNIA has done is brought to light just how much the relationship matters, and how low-cost insurance plans can force solo or small practices out of network.

“I recognize this is a zero-sum game. If we are saving $92 million, someone isn’t making $92 million, so their concern is legitimate,” Coughlin said.

But when you balance that based on sound public policy on what’s best for 9 million people, it is clear changes are needed, he said.

In addition, some for-profit hospitals are against the bill.

“For their model, they are in trouble. One of their elements is profit,” Coughlin said. “That’s their way of surviving. We are not in business of putting hospitals out of business,” but ensuring people have adequate and affordable health care is the goal.

But for-profit and out-of-network CarePoint Health System has been a vocal participant in the debates as the bills have been discussed both in the state Senate and Assembly.

Continuing the dialogue is a benefit for the public debate, said Kelly, who has provided testimony to legislators, specifically on the effects of a cap on reimbursements.

Discussions continue.

The timeline, now, is to aggressively pursue the bill’s appearance in front of the Assembly Financial Institutions and Insurance Committee and get a vote on it during the lame duck session, which is fast approaching, Coughlin said.

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Anjalee Khemlani

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