Today, Kaiser Health News published an insightful article on the Federal Surprise Bills being considered. Federal legislation is likely to significantly expand patient protection, in states that already have surprise bills enacted, by including self-funded plans under ERISA and will provide much needed protection in states where surprise bills have yet to be enacted. Details of a possible solution, in particular, how out-of-network physicians will be reimbursed remains to be seen.
The article below speaks to the rise of the PPO networks and the impact on the US healthcare system. While the article was published in 2016, the industry remains plagued with the same issues. The analogy of the healthcare players (hospitals, insurance, physicians, pharmacy, etc) to the OPEC cartels of yesteryear is very compelling and thought provoking.
On November 20, 2018, The New Jersey Department of Banking and Insurance (“DOBI”) released Bulletin No. 18-14 (the “Bulletin”) relating to Implementation of P.L. 2018 C. 32 (N.J.S.A. 26:2SS-1 to -20) Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “Surprise Bill Act”). As a reminder, the Surprise Bill Law relates to ER and involuntary out-of-network care for services rendered on or after August 30, 2018 under fully insured plans, MEWA, the State Health Benefits Program and The School Employees’ Health Benefit Program. The Bulletin is intended to provide implementation guidance regarding the Surprise Bill Law pending the adoption of rules. DOBI intends to propose such rules in the near future. Please see the Bulletin in its entirety at the link below:
The Bulletin includes references to the following attachments:
- Attachment A: Appeal and Arbitration Process Grid
- Attachment B: Application for Arbitration of Payment for Inadvertent, Emergency or Urgent Out-of-Network Health Care Services
- Attachment C: Disclosures to Covered Persons Regarding Out-of-Network Treatment
The conference room of the APA Hotel in Woodbridge was filled to capacity Monday, June 11, for the New Jersey Doctor-Patient Alliance Practice Enhancement Seminar focusing on what independent providers should do to prepare for the uncertainty coming with the new out-of-network law.
Gov. Phil Murphy signed A2039/S485 into law on June 1. Before the ink was dry on the bill, the NJDPA was already planning its seminar to help doctors and other medical providers navigate the uncertain future.
More than 300 doctors, billing specialists and other medical professionals heard presentations by leading experts in the field, including insights from state Sen. Joseph Lagana, a Democrat who has listened to the concerns raised by doctors about the out-of-network legislation.
Other speakers included Leslie Howard, Esq., the founding member of Cohen and Howard, and Joseph Ariyan, Esq., the founding member of Ariyan Law, who both deconstructed the law’s impact on medical practices.
Michael Maron, the CEO of Holy Name Hospital, gave his perspective as a hospital leader on fostering healthy relationships among doctors, hospitals and patients.
Eric Poe, the complex claims litigation officer for NJ Pure, spoke about medical malpractice, while Neelendu Bose, a healthcare compliance officer with AccordMS, explained ways to recoup money from charged off bills.