The Out-of-Network Bill

The ACC opposes the current legislative remedy to these surprise bills -- the proposed “Out-of-Network” bill, A-1952/S-1285, which arbitrarily caps payments for all out-of-network physicians at drastically low rates (benchmarked at Medicare reimbursements). Even if this bill is successful in lowering out-of-network costs for insurance companies, there is no statutory guarantee that these savings will be returned to consumers, employers or unions. Why? While health insurance profits continue to rise at record rates, premiums are not going down. Bill A-1952/S-1285 also caps all out-of-network physician payments, even for physicians who wish to be in network, but cannot find fair contracts or fair payments. State and federal laws already limit patient costs for emergency and other hospital care. The best way to limit remaining costs is to require providers and carriers to educate consumers and require robust provider networks.

We recognize there is great concern over “surprise” bills for patients exposed to bills for hospital-based care due to their employer-sponsored benefit structure. We strongly believe that increased transparency will reduce this concern. As such, we do support bill A-4228, which requires increased notice by physicians, hospitals and insurance companies to consumers about healthcare costs. Both insurance companies and providers must do better at sharing information with patients, including network status and estimated costs and liability. The bill follows guidance provided by the health financing industry itself.

Greater transparency is sorely needed. Together we can make that happen.

NEW: National Support to Hold Health Insurance Companies Accountable to Consumers
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Coalition Members

• American College of Surgeons, New Jersey Chapter
• Medical Society of New Jersey
• Mednax
• NJ American College of Emergency Physicians
• NJ Spine Society
• New Jersey Academy of Family Physicians
• New Jersey Academy of Ophthalmologists
• New Jersey Association of Ambulatory Surgery Centers
• New Jersey Association of Osteopathic Physicians and Surgeons
• New Jersey College of Emergency Physicians
• New Jersey Neurosurgical Society
• New Jersey Orthopedic Society
• New Jersey Patient Care and Access Coalition
• New Jersey Podiatric Medical Society
• New Jersey Society of Emergency Surgeons
• New Jersey Society of Interventional Pain Physicians
• New Jersey Society of Pathologists
• New Jersey Society of Plastic Surgeons
• New Jersey State Society of Anesthesiologists
• Radiology Society of NJ
• The Medical Transportation Association of New Jersey