Stethoscop and calculator

Update: The legislature has passed both out-of-network reform bills, A-2039 and S-485. Mary Beaumont, NJBIA’s vice president of Health Affairs, issued the following statement regarding the passage: 

“NJBIA thanks the sponsors and the legislators in the Senate and Assembly who voted for this important legislation,” Beaumont said. “If signed by the governor, the bill will help businesses contain costs at a time when out-of-network bills are contributing to escalating premiums and, for some companies, dropped coverage. The bill strikes a fair balance between reasonable compensation to facility-based providers and consumer protection.”

The original news release: 

The out-of-network reform bill scheduled for a vote today is a fair and balanced solution to a difficult problem and deserves legislators’ support, the New Jersey Business & Industry Association (NJBIA) said.

A-2039 (Coughlin, D-19; Schaer, D-36) is scheduled for a vote in the Assembly, and S-485 (Vitale, D-19; Weinberg, D-37) is on the board list for the Senate.

“This is an extremely difficult and complicated issue, and we commend the bill sponsors for their hard work to make sure all stakeholders’ interests were considered,” said Mary Beaumont, NJBIA’s vice president of Health Affairs. “This bill changes how out-of-network medical services are billed in a way that’s fair to both healthcare consumers and providers.”

“We thank the sponsors for this bill, which strikes a fair balance between providing reasonable compensation to facility-based providers while protecting consumers,” Beaumont said.

Out-of-network reform is necessary to protect consumers from unexpected, non-negotiable bills that drive health insurance premiums higher. Those costs have risen to an average of almost $22,000 a year for family coverage and threaten the ability of employers to continue to provide quality health benefits for their employees.

“Out-of-network costs play an increasingly significant role in the rising cost of healthcare for both large and small employers in New Jersey, triggering both higher premiums and out-of- pocket expenses,” Beaumont said. “Some employers fear that their next health benefits renewal will force them to drop coverage because the rate increase will be more than they can cope with.”

The “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” would ensure consumers receive advance notice if a provider is out-of-network, including disclosures by providers and facilities about network status, potential financial responsibility, description of the services and an estimate of the cost.

The bill also would limit what consumers would have to pay out-of-network providers in some cases and create an arbitration system to resolve healthcare billing disputes when the insurance carrier and provider cannot come to a negotiated agreement.