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Dear Colleagues, Last year, we worked with the
legislature and the NJ Hospital Association to improve care
to our psychiatric patients in hopes of reducing psychiatric
holds in our overcrowded ED’s with the passage of three
important bills. We also worked along with the Medical
Society of NJ to secure legislation which mandates that a
carrier which issues a managed care plan with an
out-of-network benefit, remit payment for reimbursement of a
health care service directly to an out-of-network provider.
We are also continuing our work with the legislature to
avoid unreasonable mandated training for coverage of ED’s in
designated children’s’ hospitals and working with a
coalition to aggressively work against the insurance
industry’s attempts to halt out-of-network reimbursement.
As a New Jersey emergency physician, this is the most
important letter you have ever received. New Jersey is at a
critical crossroads – and the physician community is smack
in the middle!
The insurance industry is working hard to convince
important State decision makers that …
…the rising health insurance premiums are directly
related to physician (and hospital) billing
…the #1 reason that we are in the middle of a health care
crisis is physician (and hospital) billing and
… the decision makers must force all physicians (and
hospitals) into insurance networks in order to reign in
insurance costs and bring down premiums.
The insurance industry has absolved itself from any
aspect of this problem. Insurance CEO salaries aren’t the
problem….nor are exorbitant premium increases that create
high profit margins. The industry explains away how even
“non-profit” carriers, such as Horizon BC/BS, can retain a
CEO who earns over $8 million.
The industry is quick to testify before legislators,
waving out-of-network bills, with no mention of what amount
was finally paid, nor any mention of how long it took to
receive the monies. The industry fails to report on
difficulties physicians have to even negotiate fair rates
for in network services; especially since there’s no
negotiation power afforded physicians.
New Jersey finds itself embroiled in a heated battle –
the physicians vs. the industry – all focused on
out-of-network reimbursement.
Legislators are beginning to host work groups and
hearings. The insurance industry is, as you would expect,
very well organized and well funded. Now it’s time for the
physician’s voice to be heard!
A large of coalition of 20+ organizations – including all
the State’s physician organizations, hospitals and ASCs –
have come together and developed a sound, workable strategy
to push back on the industry’s attempts to halt
out-of-network reimbursement. But we need your help! As you
can imagine, this is a large undertaking and it will be
expensive.
But, there really is no bigger issue facing medicine
in New Jersey. STATPAC is soliciting to help fund the
work of this important OON coalition. Please give now (suggested
amount is $300.00 per physician representing approximately 3
hours of pay). Your NJ-ACEP Board of Directors is
overseeing the efforts, and has a strong voice at the table.
Simply click on our new STATPAC website –
www.njstatpac.org --
that allows you to contribute on line. Your help is needed
and appreciated.
William B. Felegi, D.O., FACEP
Chairman, STATPAC |
