A-952

The Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act/Health Price Index

NJEA supports A-952 (Singleton, Coughlin, Schaer, Lampitt, Spencer, Lagana). The purpose of this bill is to increase transparency in pricing for health care and enhance consumer protections by preventing unexpected costs to the consumer.  The legislation will also help contain rising health care costs and creates a process for resolving health care billing disputes.

This bill increase transparency by requiring

  • Health care facilities and health care professionals to provide patients undergoing non-emergency treatment or an elective procedure with written disclosure of information regarding whether the providers are in-network or out-of-network according to their insurance plan and the circumstances under which they may incur out of pocket costs.
  • The facility or professional to provide patients with a description of the procedure involved in their care and information regarding all related costs.
  • Insurance companies to publish a list of all in-network providers and make this information available on a regularly updated website.  Insurance companies also need to make information available to allow covered individuals to estimate out-of-pocket costs.
  • The establishment of a “Healthcare Price Index System” (HPI), to collect data that can be used to provide valuable information about the usage and costs of health care in New Jersey. This non-proprietary information would be made available to businesses, consumers, providers, policymakers, and insurers alike to make better-informed decisions about cost-effectiveness and the quality of care.

This bill protect consumers by

  • Ensuring that out-of-pocket costs for patients who receive medically necessary emergency services at an out-of-network facility, or who inadvertently receive care from an out-of-network professional, will cost no more than the same services provided by in-network providers.

This bill will help contain rising health care costs by

  • Establishing a system of binding arbitration when providers and carriers cannot agree on payment of out-of-network claims.

                                                                                                                        (over)

  • Prohibiting providers from waiving any copayments or deductibles owed by individuals under their health care plans.  NJEA would recommend that the bill explicitly prohibit prescription co-pays and coinsurance from being waived as well.

NJEA supports this bill because in addition to increasing transparency and protecting consumers, this bill could provide cost savings to employers who provide insurance, including the state.  Measures that reduce costs and improve quality of care should help stabilize our members’ premium costs.  Further, at a time when NJEA members are paying more and more each year in health care premiums, it is essential that our members are provided as much information as possible when receiving medical care in order to limit their out-of-pocket expenses. 

NJEA has been proactive in seeking ways to contain overall healthcare costs.  Studies show that while the United States spends more dollars on health care services than other countries, Americans do not necessarily enjoy better health outcomes.  NJEA believes that the overwhelming costs of health care must be examined in order to produce a healthier population and better quality of care.  This bill takes an important step toward that end.

NJEA urges you to support this legislation.