PROTECTING PATIENTS FROM MASSIVE OUT OF NETWORK COSTS IS A GOOD IDEA BUT NJ MUST AMEND ITS CURRENT BILL WHICH INTENDS TO DO THAT

There is an important vote on the horizon in the New Jersey state Senate that should be of interest to everybody nationwide, because it could potentially serve as a model for other states.

S-485 is a bill intended to grapple with the exceedingly high costs of out of network care for patients. The bill is a good idea and well-intentioned, which is why so many physicians support the transparency and disclosure requirements included in it.

However, before it passes, there are issues that need to be resolved in order to avoid some potentially egregious issues.

For starters, the dispute resolution mechanism in the bill is badly skewed in favor of insurers. It allows them to skimp on payment to doctors, but does nothing to guarantee the savings get passed on to patients.

Numerous insurers have spent millions on lobbying and advertising rather than on patient care and there is no mechanism in this bill to keep this from continuing to happen.

Hospital and physician costs have risen at a marginal rate of less than 2% while insurance premiums have continued to go up at record rates. This indicates an increase in administrative costs and lucrative salaries at insurance companies rather than an honest accounting and best-practices attempt to properly serve patients.

Simply put, while the bill should pass in some form because it is necessary to protect patients from exorbitant out of pocket costs, the way it is curretly constructed does not accomplish that.

Fixes need to be made.

What kind of fixes? Here are some potential ideas:

-Ensure arbitrators use market based charged data when issuing decisions. The unilateral use of health insurance payer payment methodology in arbitration would allow health insurance carriers to revert to deceptive business practices which were outlawed in New Jersey years ago.

-Get rid of the parts of the bill that permit federally-regulated plans to “opt in” to state arbitration.

- Make the process of granting waivers for patient cost sharing far easer, since it would allow physicians to help their indigent patients get care.

-Get rid of punitive measures for struggling to properly adhere to difficult payment plans. These plans should be easy to understand and easy to comply with.

As a doctor myself, I want what is best for patients and patient care.

I understand insurance companies need to make a profit, but patients are getting crushed with out of network costs and this bill needs to be put in place to stop that from happening.

This current bill is flawed, but worth fixing.

I have great faith in the men and women of New Jersey state government to realize the shortcomings of the bill and make the appropriate changes for the good of the hard working men and women of the garden state.

I have no doubt that in the end, they will do the right thing and put the needs of patients first.

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