Skip to main content
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Digital Health
    • Transformation
    • ESG
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • Newsletters
  • MORE+
    • Contact Us
    • Advertise
    • Media Kit
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Providers
April 13, 2018 01:00 AM

N.J. tries to shore up state Obamacare, shield patients from surprise bills

Susannah Luthi
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print
    Tim Larsen
    Governor Phil Murphy

    New Jersey lawmakers took three big steps to make patients happy this week, with measures to lower Obamacare premiums and increase transparency for out-of-network costs.

    The latter bill has divided the healthcare community, concerning some physicians who say the bill's administrative burdens could drive doctors out of the state. The hospitals have endorsed the measure.

    On Obamacare, the Legislature's two-part plan to shore up the state health exchanges leverages an individual mandate penalty—the first to be passed by a state legislature—to fund a reinsurance pool. New Democratic Gov. Phil Murphy will need to sign it into law, but the state's General Assembly passed the two measures with comfortable margins Thursday. The bill aims to lower premiums next year for the roughly 275,000 people in the state exchanges.

    The less-publicized Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act also passed after being on the docket for almost a decade. It faced continued controversy in the medical community.

    "This legislation will add to an already difficult practice environment for physicians," Christopher Gribbin, president of the Medical Society of New Jersey, wrote in comments about the bill. "If out-of-network physicians are unable to charge and collect market-based fees, New Jersey will suffer."

    But Cathy Bennett, president and CEO of the New Jersey Hospital Association, urged Murphy to sign the bill.

    "The out-of-network bill … is eight years in the making, and in the end it addresses our two key priorities: protecting patients from surprise medical bills, and ensuring that hospitals and physicians are on a level playing field with insurance companies when it comes to negotiating fair payments for the care they deliver," Bennett said.

    This bill steps up requirements on providers. Among other mandates, providers would have to tell their patients before scheduling an appointment whether the provider is in or out of the person's insurance network, as well as disclose all the financial liability the patient is likely to have for the given procedure.

    The measure also puts robust reporting and transparency requirements on carriers.

    Gribbin praised some aspects of the disclosures but also decried the arbitration rules that insurers and providers will have to use to resolve disputes and the extra administrative complexity added to already-complex billing systems.

    "For too long, healthcare consumers have been surprised about the amount of insurance coverage their healthcare policy provides," he noted. "The disclosures required by insurers and healthcare providers will give consumers more information about their financial responsibility."

    However, he added, the group "continues to feel that baseball-style arbitration is inappropriate for settling healthcare payment disputes and advocates using the existing arbitration system."

    Ultimately, the new complications for payments will raise healthcare costs, Gribbin said.

    In 2015, New York enacted a law that protected patients from so called "balance billing." Instead of patients receiving bills, insurers and providers have to resolve the issue through a dispute resolution process. In its first year, data showed that insurers prevailed in disputes more often than providers in several hundred conflicts adjudicated by the state's independent entity. Of 291 disputes over bills for emergency services, the amount paid by health plans was deemed reasonable in 22% of those cases. Providers won 13%, according to preliminary data.

    A Kaiser Family Foundation study found that in 2011, New York state officials studied more than 2,000 complaints involving surprise medical bills, and found the average out-of-network emergency bill was $7,006. Insurers paid an average of $3,228 leaving consumers, on average, "to pay $3,778."

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    20160830_Mike_Pykosz_mm0146(1).jpg
    Q&A: Oak Street Health CEO on growth plans after CVS Health deal
    Rapid growth predicted for hospital-at-home market
    Rapid growth predicted for hospital-at-home market
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare A.M. Newsletter: Sign up to receive a comprehensive weekday morning newsletter designed for busy healthcare executives who need the latest and most important healthcare news and analysis.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Digital Health
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • ESG
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • Newsletters
    • MORE+
      • Contact Us
      • Advertise
      • Media Kit
      • Jobs
      • People on the Move
      • Reprints & Licensing