S 485

The Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act

NJEA supports S-485 (Vitale, Weinberg).  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 increases transparency by requiring health care facilities and professionals to provide patients with information about providers’ network status and possible costs patients may incur when they voluntarily use an out-of-network provider.  The bill also requires carriers to publish a list of in-network providers on their website and to provide information about possible costs patients will incur for out-of-network services for specific procedures.

This bill protects consumers by ensuring that patients who receive inadvertent or emergency services from out-of-network providers cannot incur out-of-pocket costs greater than if they had received treatment from in-network providers.

This bill should 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.  Furthermore, the bill also prohibits providers from waiving any copayments or deductibles owed by individuals under their health care plans.

NJEA supports this bill because of its consumer protections and because it should help provide costs savings for employers, including the state which will help stabilize our members’ premium costs.  At a time when NJEA members are experiencing a negative net in their take home pay because of the rising costs of health care premiums, it is essential that our members are provided as much information as possible when receiving medical care in order to limit future 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, Americans do not necessarily enjoy better health outcomes.  NJEA believes that the overwhelming costs of health care must be examined 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.

Text of bill


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