Out of Network Bill

UPDATE: On Monday, December 5th, the sponsor of the bill, Senator Joe Vitale, Chair of the Senate Health Committee, delayed action on the legislation to give stakeholders more time to reach a compromise.

Brand new coalitions have been created in recent weeks to both support and oppose out of network reform. Horizon Blue Cross Blue Shield of New Jersey is funding one group: “Better Choices, Better Care, NJ” made up primarily of business and labor groups. NJPCAC is participating in another coalition – the “Access to Care Coalition” – consisting of medical providers.

There appears to be general agreement on issues of transparency and disclosure – assuring that patients are told by their Plan or Provider what is covered and what is not prior to a non-emergency treatment. Where the disagreements lie is in how to resolve disputes. Horizon and some labor unions would like to move to an arbitration system that relies on a percentage of Medicare as the benchmark, while NJPCAC and other hospitals and providers are pushing for a system that would recognize fair market value.

Final legislative action on the out of network bill is not expected by the end of the year. However, at least one committee – the Senate Budget and Appropriations Committee – has scheduled a hearing on the matter in December.

NJPCAC members are encouraged to participate in the Medical Society of New Jersey’s “Action Alert” on the Out of Network issue. You can easily contact your own legislators by going here:http://www.cqrcengage.com/msnj/app/write-a-letter?1&engagementId=149533