N.J. lawmakers tackle surprise out-of-network medical bills: 5 things to know

The New Jersey legislature intends to take action on "surprise" medical bills with a new law requiring greater financial transparency by hospitals and insurance networks. 

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. According to a bill obtained by N.J. Advance Media, hospital officials and administrators would be legally obligated to disclose which providers are covered and which are not.

Below are five key factors at play in the legislative and financial debate.

1. New Jersey hospitals are known as some of the most expensive in the nation based on an out-of-network price list released by CMS.

2. The bill pertains to non-emergency and elective surgical procedures only.

3. The bill's latest version outlines a third-party arbitration process to settle billing disputes between insurance companies and healthcare providers as a means to protect consumers. 

4. Physicians would be required to provide the name and address of any other specialists involved in patient care so the consumer may determine network status and potential out-of-network costs.

5. The Medical Society of New Jersey criticized earlier attempts by the N.J. legislature to pass similar bills, saying it punishes all doctors for the bad practices of a few.

The "Out-of-Network" bill is the latest in a string of unsuccessful attempts to rein in a $1 billion problem that drives up premium costs for policyholders, according to major insurance carriers in New Jersey. Lawmakers hope to pass the bill before the end of legislative session in January.

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