NJ-ACEP News

ACCESS to CARE COALITION UPDATE

  • 6 December 2016
  • Author: Lauren Myers
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Members of the Access to Care Coalition and the Legislature held a news conference today at the State House in Trenton on December 5, 2016 to voice opposition to the Out-of-Network Bill A-1952/S-1285 and support for Bill A-4228/S2674.The group unanimously supports bill A-4228, which requires increased notice by physicians, hospitals and insurance companies to consumers about healthcare costs.   

“We want to make sure there is more transparency from health insurers, so that consumers are not hit with surprise bills for out-of-network services,” said Larry Downs, CEO, Medical Society of New Jersey. “That’s why we support Bill -4228 and oppose Bill A-1952/S-1285.”   

 

The Access to Care Coalition, comprised of twenty groups representing more than 10,000 physicians and other providers, came together to address inconsistencies within New Jersey consumers’ health plan coverage; to call for more transparency from health insurers and to address the issue of surprise bills that can accompany out-of-network healthcare services.   

“Many patients think if they have an 80/20 health insurance, the insurance company will pay 80 percent of the bill, but that is not always the case,” said Dr. Rajnik W Raab, a neurosurgeon.  “What often happens is that insurance companies will pay only eighty percent of the Medicare reimbursement rate, leaving patients responsible for paying much more than they expected.”   

Several other physicians spoke of the difficulties they and their patients face on a regular basis in terms of out-of-network, surprise bills, including Dr. Joseph Costabile (surgery), Dr. Nicole Saphier (radiology), Dr. Mark Rosenberg (emergency), and Dr. David Dupree (surgery).   

Members of the legislature spoke today in support of the Coalition’s goals, including Assembly Republican Leader Jon Bramnick, Assemblywoman Nancy J. Pinkin, Assemblywoman Amy H. Handlin, and Assemblywoman Nancy F. Munoz. 

Soeren Mattke, Senior Scientist, RAND Health, outlined findings from the study he co-authored titled, “Evaluating the Impact of Policies to Regulate Involuntary Out-of-Network Charges on New Jersey Hospitals (http://www.rand.org/pubs/research_reports/RR1809.html). The report suggests that implementing New Jersey Bill A-1952, which proposes a limit of between 90 and 200 percent of Medicare rates for involuntary out-of-network hospital care, would have reduced payments for hospital care by commercial plans by between 6 and 10 percent during 2010 through 2014. Assuming no change in operating expenses and no recoupment of lost out-of-network revenues, the cap would have led to an operating loss at between 48 and 70 percent of hospitals. 

For more information on the Access to Care Coalition, please visit www.accesstocarecoaltion.com.

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