April 19, 2018

Out-of-Network Legislation in NJ Spurs Opposition

New Jersey’s proposed out-of-network billing act has generated enough support for passage by the state senate and assembly despite opposition from many of the state’s major medical stakeholders.

The “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” (AB 2039) aims to reduce the possibility of “surprise billings” for out-of-network medical services. The Access to Care Coalition stated in its testimony, “Physicians support the transparency and disclosure requirements included in this bill. However, the dispute resolution mechanism, ‘opt in’ provisions and penalties in the bill drastically tilt the scales in favor of insurers and disadvantages patients and their physicians and hospitals.”

Medical community stakeholders argue that, if enacted, the bill would increase the complexity of medical billing and reimbursement and would impede physicians from charging and collecting market-based fees to the detriment of New Jersey’s overall health care system. One of the bill’s provisions attempts to adjudicate claims submitted to self-insured plans (ERISA plans regulated by federal law). Because such plans account for a large share of the state’s health services market, the provision may result in litigation.

AB 2039 was sent to New Jersey Gov. Phil Murphy, who has the option of signing or vetoing the bill or seeing the bill become law without his signature 45 days after legislative approval.

Legislatures in Alaska, Pennsylvania, Minnesota, New Hampshire and Rhode Island are also considering out-of-network legislation this year.