If you’ve been looking for the hospital bill that illustrates the difference between in-network and out-of-network costs — and the fight between hospitals and insurers that goes with it — we’ve found it.
That’s what happened when reports of an $8,775 bill from Bayonne Medical Center to bandage a cut finger in the emergency room surfaced.
And while all parties involved admit the cost is out of line, how to fix it — and who is at fault for it — is not so easily agreed upon.
The bill, the result of an emergency room visit from a Bayonne man in 2013, has reignited calls for Trenton to clamp down on excessive “out-of network” ER costs that can result when patients show up to a hospital that’s not in their health insurance company’s network.
But the passionate response from health care stakeholders — with hospitals questioning whether insurers pay them a fair rate, and insurers contending some hospitals abuse out-of-network charges to shore up revenue — suggests it could be just as tough to find a consensus now as it was in 2010, when lawmakers tried and failed to regulate out-of-network hospital bills.
State Sen. Joseph F. Vitale (D-Woodbridge) said he’s ready to try again.
Vitale said in the Bayonne case, insurer UnitedHealthcare “was slammed for thousands of dollars for taking care of what was essentially a booboo. And that is absurd.”
He noted that under state law, a patient who gets emergency care at an out-of-network hospital is supposed to encounter the same billing terms as if that hospital were in-network. The insurance company, however, may have to pay hospital “charges” — prices that hospitals post but then routinely negotiate downward when they join an insurance company network.
And here’s the problem with that: When insurers pay high out-of-network charges, those costs get baked into the health insurance premiums that everyone pays.