Out of Network

The Affordable Care Act did a lot to expand access to health care and help make the cost more affordable for millions of consumers. But making health care more affordable will require us to change the business of health care.

Consumers need accurate and timely information to make decisions about their health care costs. What those costs are shouldn’t come as a surprise. But often they do because New Jersey law does not protect consumers against bills for services they inadvertently receive from an out-of-network provider. Today, even consumers who take care to make sure the doctor or hospital they choose is “in-network,” can be on the hook for a surprise medical bill for thousands of dollars.

We need to require provider disclosures that ensure consumers get the information they need to avoid unintended out-of-network charges in the first place. And, we need protections that guarantee consumers will not be on the hook for higher out-of-network costs when no other suitable “in-network” choice is available. Instead, consumers who make a good-faith effort to receive care from in-network providers should only be responsible fo rthe same costs they would have had if the provider had been in-network.

The Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (A4444/S20) would change the status quo. Doctors and hospitals would be required to give consumers advance notice about which insurance networks they participate in and a good faith estimate of what their care will cost. This bill would extend protections so consumers who go to an in-netowrk hospital or surgical center and inadvertently receive care from an out-of-network doctor cannot be held responsible for higher out-of-network rates, as is currently the case in emergency situations. Instead, the consumer would be held harmless and the doctor and the insurer would have to negotiate a fair reimbursement price, through arbitration.

Stand with us in urging legislators to put an end to these abusive out-of-network billing practices and protect consumers against these unfair and unexpected financial burdens.