4 things to know about New Jersey's hospital billing debate

New Jersey lawmakers are poised to try again to curb surprise medical costs across the state, but recent developments affecting the state's hospitals may make it harder, The Record reports.

Here are four things to know about New Jersey's hospital billing debate.

1. Last year, a New Jersey bill that requires greater financial transparency by hospitals and insurance networks essentially died after state lawmakers tabled the proposal due to lack of support. Aptly named the "Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act," the bill aims to protect consumers from extraordinary costs post-surgery for unknowingly receiving out-of-network care.

2. Now Sen. Gerald Cardinale, DD, (R-Demarest) has started circulating a new version of the legislation. Sen. Cardinale's version would rely on peer review — one panel for physicians and one for hospitals — to settle disputes when insurers and out-of-network providers disagree on the amount that should be paid for a service, according to the report. The Record notes that the original version of the bill relied on "baseball arbitration" — a choice of one side's final offer — by outside professional arbitrators.

3. It could be difficult to pass Sen. Cadinale's bill, given other issues in the state that may negatively impact hospital finances. Horizon Blue Cross Blue Shield of New Jersey launched its OMINA health plan, under which half of the state's 62 hospitals were labeled as Tier 2, a status expected to lead fewer patients to seek care at their facilities, and thus lower revenues, The Record reports. Additionally, 30 nonprofit hospitals face lawsuits that could cost them their property tax exemptions.

4. Still, the Democratic sponsors of the measure that failed last session have met with interest groups and say they plan to meet again to see what changes might help the bill win passage, according to the report. And consumer advocacy group Citizen Action is slated to call attention to the problem of surprise medical bills at an event in mid-June.



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