This is about New Jersey, but the concept applies everywhere.
If there ever was an example of bureaucratic stupidity mixed with political incompetence this is it. Note in the quote below that the problem of out-of-network balance billing is particularly associated with emergency care. Then note the main requirements of the bill apply prior to “non-emergency care.”
Murphy signed legislation that is designed to protect you from getting hit with those surprise out-of-network medical bills that seem to show up when you go to the doctor for even the smallest ailment. Or, as Murphy put it, the legislation is for those tens of thousands of New Jerseyans each year who are “getting screwed” by surprise medical costs – particularly when they’re dealing with emergency care.
Just what we need, more bureaucracy and administration placed on health care providers … more costs for patients. And all this pretty much accomplishes nothing. Think anesthesiologist or radiologist; the two most common incidences of balance billing. And if all this applies to non-emergency health care, what is stopping the patient from simply asking if a provider participates in their plan?
Balance billing can be a problem in some instances and that could be solved just as Medicare does; limit billing by non-participating providers to 115% (or other percent) of the participating provider allowed fee. Instead NJ creates more administrative costs. Bazinga‼️
Here is a summary of the requirements of the legislation excerpted from the above article.
The bill requires health care facilities, prior to non-emergency or elective procedures, to:
• disclose to patients whether the health care facility is in-network or out-of-network in respect to the patient’s health benefits plan;
• advise patients that, if the facility is in-network, the patient will not incur any out-of-pocket costs outside of those typically applicable to an in-network procedure unless he or she has knowingly, voluntarily, and specifically selected an out-of-network provider to provide services;
• inform patients that, if the facility is out-of-network, the patient will have a financial responsibility applicable to health care services provided at an out-of-network facility.
In addition, health care facilities will be required to make available to the public a list of the facility’s standard charges for items and services it provides.
The bill will also require health care professionals, verbally or through a website, to disclose to covered patients the health benefits plans in which they are participating providers as well as the facilities with which they are affiliated, prior to non-emergency services at the time of an appointment.
If the health care professional is out-of-network, the bill also requires health care professionals to:
• inform patients that they are out-of-network and that the estimated amount to be billed for services is available upon request;
• disclose to patients, in writing if requested, the amount the health care professional will bill absent of unforeseen medical circumstances that may arise when the medical service is provided; and
• advise patients that they will have a financial responsibility applicable to health care services provided by an out-of-network professional in excess of their copayment, deductible, or coinsurance, and that they may be responsible for any costs in excess of those allowed by their health benefits plan.
The bill also places the responsibility on health care professionals to provide to patients, as practicable, contact information of any health care providers scheduled to perform anesthesiology, lab, pathology, radiology or assistant surgeon services in connection with the care to be provided, and to recommend that the patient contact their carrier to learn more about any costs associated with these services.