ROI-NJ: Arbitration still key to out-of-network legislative fight

By Anjalee Khemlani

Read this article as it originally appeared on March 6, 2018 in ROI-NJ.

The ongoing battle over out-of-network legislation to help curb the cost of non-emergency, surprise medical bills continues to hinge on the tools arbitrators are given to help resolve disputed bills.

One side wants baseball-style arbitration, in which either the billed amount or the amount the insurers offer is chosen, while others want to use the 80th percentile of FAIR Health, which is used in New York and Connecticut as a benchmark of usual and customary rates, to reimburse doctors.

ROI-NJLogo-1200x800.jpgDoctors who testified at the Assembly Financial Institutions and Insurance meeting also brought a new flavor to the battle, sharing their harrowing experiences in emergency situations that resulted in unexpected out-of-network bills for patients.

“Insurance companies won’t pay me,” said Dr. David Dupree, a surgeon affiliated with Riverview Medical Center and Hackensack Meridian Health.

“For example, I did a ruptured spleen on a 22-year-old girl, and I saved her life. On a Friday night. I saved her life, she was dying. She went home Monday morning. The insurance company refused to pay the $672 bill because I didn’t get it authorized.”

Dupree also stressed a point that has been brought up in previous years at out-of-network hearings: The more control that is shifted away from doctors to negotiate their pay, the harder it will be to attract doctors to the state.

Despite the doctors who testified all sharing reasons for being out-of-network, many attendees complained after the hearing that few lawmakers asked tough questions related to the legislation and its mechanisms for handling the billing problem.

“On occasion, you can end up in a circumstance where it’s out-of-network and you are finally able to get paid enough money, not commensurate with what you do, but at least allow you to pay your bills. That’s a … backwards way for the system to work,” said the committee chairman, Assemblyman John McKeon (D-Madison).

“We are 90 percent there.”

The bill was voted out of the Assembly committee and will next be heard in the full Assembly.

A similar bill was pulled from the Senate Commerce committee agenda Monday.

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