New Jersey consumer group seeks greater protections against surprise medical bills

Consumer advocates in New Jersey are pushing for more state protections for people who get hit with unexpected medical bills. That’s in light of recent deliberations over proposed legislation.

NJ for Health Care, a statewide coalition, released a paper in conjunction with Consumers Union Wednesday, supporting efforts to pass the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act.”

The report highlighted a practice that’s often referred to as surprise billing.

It’s when a patient goes to an in network doctor or facility, meaning one that is covered by insurance, but then receives a bill anyway for something related to that care, maybe from an out of network anesthesiologist or surgery room.

It happened to the wife of Arthur Church, of North Arlington, after having a tumor removed earlier this year.

“And a month later we received a bill for $19,000 because the doctor was in network but the hospital wasn’t. And it was a hospital bill,” said Church.

Church says after a seven month appeals process he “thinks it’s taken care of.”

NJ for Health Care organizers have featured Church’s story and others as part of their new report. They say it’s hard to know how common surprise billing is in New Jersey but worry the dozens of stories they’re learning about are just “the tip of the iceberg,” and that many patients wind up footing large bills.

“Too often these bills are being presented to consumers, and consumers are on the hook and being held responsible for situations and for bills that they had no choice or control in making,” said Maura Collinsgru with NJ Citizen Action.

The report also outlined state policy recommendations, such as establishing disclosure rules about what is and isn’t covered before a procedure, a public database of health care prices, and an arbitration process that takes patients out of the process to settle payment disputes between insurers and providers.

New Jersey lawmakers have been considering legislation. It didn’t go anywhere this spring.

Tensions surfaced between providers and insurers about price disclosures and payment negotiations.

“The bill in its current form really kind of disrupts the entire market for physician services,” says Larry Downs, CEO of the Medical Society of New Jersey. His group would favors resolving “outlier charges on a case by case basis.”

Bill sponsors recently called for more input from the health care community on the proposed policies.

The issue of surprise medical bills has surfaced in other states. It was a top complaint to New York’s financial services office. That enacted new protections that took effect this spring. 

In neighboring Pennsylvania, the state insurance department has received several complaints and scheduled a public hearing on the issue next month.

Related: Out-of-network bill hits snag in state Senate, likely delayed until fall