Murphy Signs Bill Into Law For Those 'Screwed' By Health Costs

New Jersey Gov. Phil Murphy signed a bill into law Friday that could lead to some of the biggest changes to your health care yet – and even bigger than the Obamacare law he signed on Wednesday.

Murphy signed legislation that is designed to protect you from getting hit with those surprise out-of-network medical bills that seem to show up when you go to the doctor for even the smallest ailment.

Or, as Murphy put it, the legislation is for those tens of thousands of New Jerseyans each year who are "getting screwed" by surprise medical costs – particularly when they're dealing with emergency care.

The “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act” is designed to increase transparency in pricing for health care services, enhance consumer protections, create a system to resolve certain health care billing disputes, contain rising costs and measure success with respect to these goals.

"Today is long overdue," Murphy said at the start of the press conference.

Murphy said 170,000 New Jerseyans every year get medical bills they don't expect. "Residents shouldn't have to worry that an emergency trip to the hospital could be bankrupting," he said.

"Today, at long last, NJ consumers win," he said.

Watch the video of the signing below.

The legislation, sponsored by Senate Health Committee Chair Joseph F. Vitale, is intended to provide greater transparency and consumer protection.

“When people choose a health insurance plan, the details of in-network and out-of-network services and fees should be clearly spelled out from the onset of coverage – not once the insured becomes the patient,” said Vitale, D-Middlesex. “When you’re sick, the last thing you need is to be saddled with the added burden of figuring out costs and options. This bill remedies that situation and protects New Jersey patients against unethical practices and surprise out-of-network charges when they are at their most vulnerable.”

The bill requires health care facilities, prior to non-emergency or elective procedures, to:

• disclose to patients whether the health care facility is in-network or out-of-network in respect to the patient’s health benefits plan;
• advise patients that, if the facility is in-network, the patient will not incur any out-of-pocket costs outside of those typically applicable to an in-network procedure unless he or she has knowingly, voluntarily, and specifically selected an out-of-network provider to provide services;
• inform patients that, if the facility is out-of-network, the patient will have a financial responsibility applicable to health care services provided at an out-of-network facility.

In addition, health care facilities will be required to make available to the public a list of the facility’s standard charges for items and services it provides.

The bill will also require health care professionals, verbally or through a website, to disclose to covered patients the health benefits plans in which they are participating providers as well as the facilities with which they are affiliated, prior to non-emergency services at the time of an appointment.

If the health care professional is out-of-network, the bill also requires health care professionals to:

• inform patients that they are out-of-network and that the estimated amount to be billed for services is available upon request;
• disclose to patients, in writing if requested, the amount the health care professional will bill absent of unforeseen medical circumstances that may arise when the medical service is provided; and
• advise patients that they will have a financial responsibility applicable to health care services provided by an out-of-network professional in excess of their copayment, deductible, or coinsurance, and that they may be responsible for any costs in excess of those allowed by their health benefits plan.

The bill also places the responsibility on health care professionals to provide to patients, as practicable, contact information of any health care providers scheduled to perform anesthesiology, lab, pathology, radiology or assistant surgeon services in connection with the care to be provided, and to recommend that the patient contact their carrier to learn more about any costs associated with these services.

Should a primary care physician or internist perform an unscheduled procedure in his or her office, it would be permissible to provide the required notice verbally at the time of the service.

Under the bill, health insurance carriers would also be required to update their websites within 20 days of the addition or termination of a provider from the carrier’s network or a change in a physician’s affiliation with a facility.

With respect to out of network services, the bill will require health care carriers to provide covered persons in each health benefits plan offered with:

• a clear and understandable description of the plan’s out-of-network health care benefits, including the methodology used by the entity to determine the allowed amount for out-of-network services;
• the allowed amount the plan will reimburse under that methodology and, in situations in which a covered person requests allowed amounts associated with a specific Current Procedural Terminology code, the portion of the allowed amount the plan will reimburse and the portion of the allowed amount that the covered person will pay, including an explanation that the covered person will be required to pay the difference between the allowed amount as defined by the carrier’s plan and the charges billed by an out-of-network provider;
• examples of anticipated out-of-pocket costs for frequently billed out-of-network services;
• information in writing and through an internet website that reasonably permits a covered person or prospective covered person to calculate the anticipated out-of-pocket cost for out-of-network services in a geographical region or zip code based upon the difference between the amount the carrier will reimburse for out-of-network services and the usual and customary cost of out-of-network services;
• information in response to a covered person’s request, concerning whether a health care provider is an in-network provider;
• such other information as the commissioner determines appropriate and necessary to ensure that a covered person receives sufficient information necessary to estimate their out-of-pocket cost for an out-of-network service and make a well-informed health care decision; and
• access to a telephone hotline that shall be operated no less than 16 hours per day for consumers to call with questions about network status and out-of-pocket costs.

Murphy just signed 14 bills into law on Wednesday, including one that makes a big Obamacare change that will impact all New Jerseyans.

Murphy signed legislation, A-3380, that restores the mandate - just for New Jerseyans – that everyone must obtain health insurance or pay a tax, though it's not completely clear how much that fee will be.

Read more: Gov. Phil Murphy Signs 14 Bills Into Law, Making Big Obamacare Change

Congress essentially gutted the federal Obamacare mandate in December. Under the individual mandate, most Americans were required to purchase health coverage, but starting Jan. 1, 2019, there is no fee associated with the individual mandate. The new state mandate law will take effect on Oct. 1.

Watch the video of the signing below:

Gov. Phil Murphy photo