Why S-1285 is bad for New Jersey patients

S-1285 is insurance-industry driven legislation. That means insurance industry lobbyists are trying as hard as they can to push this bill through the Legislature.

Insurance industry lobbyists have been at it for years. It continues to be the second most well-funded issue in terms of lobbying dollars, behind transportation.

SenNiaGill1200x900.pngHorizon alone spends more than $700,000 per year on this effort.

Why are they fighting so hard for this bill? It’s simple. It’s all about money. If it passes, insurance companies make more money, while limiting your healthcare choices.

S-1285 targets the portion of your health insurance that provides coverage when a doctor is not in your network.

Most people who have health insurance may not think much, if at all, about the out-of-network (OON) benefit on their health insurance policy until life delivers a dose of bad news.

Consider this scenario: you have a diagnosis that requires the attention of a specialist. Your doctor or family friend highly recommends a specialist – the best in the medical profession, the one they would see if they received the same diagnosis.

After checking with your insurance company, you discover the highly-recommended specialist is not in your network.

If you have OON benefits, no worries, you have the choice to seek the best medical care. You can go ahead and see that specialist with the most expertise to treat your diagnosis. That doctor will bill your insurance company and you will pay some out-of-pocket expense as determined in your insurance policy.

Insurance-industry lobbyists who are trying to limit your healthcare choices cite the same tired examples that have been trotted out over and over again: the $49,000 bill for a broken bone, the $59,000 bill for kidney stones. Yes. these are outrageous, egregious examples, but they are not the norm.

The vast majority of “surprise” medical bills are not egregious at all, but merely reflect a published guide that lists Usual, Customary, and Reasonable fees (UCR). This published UCR guide takes into account the high cost of providing medical services in states such as New Jersey. 

UCR may appear high in comparison to Medicare. But Medicare cannot ever be used as guide for reasonable charges. Medicare can pay a neurosurgeon less, for saving a human life, than the neurosurgeon has to pay a plumber to fix a sink.

The reality is these few rare examples have become the poster children for insurance industry lobbyists. They’d want to shine the light on these few examples to distract consumers from the inadequate networks and benefits offered by insurance carriers.

Insurance carriers mislead consumers about the benefits offered in their expensive health plans. This practice leaves patients with nasty financial “surprises” at the most vulnerable time in their lives – when they need emergency medical attention.

The New Jersey Doctor-Patient Alliance supports S-3299 sponsored by Sen. Paul Sarlo, which will hold insurance companies accountable for the medical benefits they promise. If, for example, a police officer buys an expensive out-of-network plan that promises to pay 80 percent of charges, S-3299 will obligate the insurance carrier to come clean about what, exactly, that 80 percent refers to.

What S-1285 would do is limit the amount that your doctor would be paid to a pittance. 
You may be thinking, who cares? Doctors get paid enough.

The sad reality is that doctors will stop treating patients who aren’t fully insured. They may only take patients who agree to pay the full cost up front. Specialists will stop working the on-call shift at emergency rooms. Doctors will even leave the state.

That puts your health at risk.

So please call Sen. Nia Gill at (973) 509-0388 and tell her to vote against S-1285 and support S-3299 instead.

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  • commented 2017-06-30 07:12:51 -0400
    More government interference in the doctor patient relationship. How about the gov’t applies the same rules they do to the Atty client privilege and tackle slip and fall lawyer suits against medical professionals. Only then will we have truly affordable access to doctors. It’s none of government’s business what occurs between a patient and a doctor. But because politicians are Robin hoodlums they take $$$ from the state and give it to their friends who lobby them the most extensively. There is a coming shortage of doctors like the county has never seen before. This type of legislative favoritism will force docs to leave the state….. like the rest of us over taxed citizens.