U.S. Senator Bob Menendez today joined patients and consumer advocates at New Jersey Citizen Action headquarters in Newark to announce bipartisan legislation aimed at protecting patients from surprise, unanticipated medical bills that too often can lead to a patient's financial ruin. These costly bills frequently occur when a patient receives emergency care from an out-of-network hospital, or is treated at an in-network facility only to find out later that one or more of their treating providers fall outside their insurance network.
"Health care coverage is supposed to protect you from financial ruin in the event of an illness or injury. Unfortunately, it doesn't always work out that way. Every year, millions of Americans who think they have great coverage still get wacked with huge and totally unexpected medical bills," said Sen. Menendez. "It's time for Congress to take action, and that's why I recently joined a bipartisan group of my Senate colleagues as a sponsor of the STOP Surprise Medical Bills Act."
According to a 2016 New Jersey Policy Perspective report, some 168,000 patients in the state received a surprise bill from an out-of-network provider costing them a combined $420 million a year.
Sen. Menendez, who is a senior member of both the Senate Finance Committee that sets national health policy, and Banking Committee, was joined by several New Jerseyans hit with a surprise medical bill.
A year after Meredith Ribero gave birth to her son, the Westfield mom received a surprise medical bill for $1200, despite delivering at an in-network hospital by an in-network gynecologist. She was unaware that the anesthesiologist who administered her epidural was out-of-network.
Liz DeMarco was hit with over $100,000 in surprise medical bills when the New Jersey hospital worker suffered a ruptured brain aneurism while on the job and had to be transferred to an out-of-network hospital with an out-of-network surgeon both better equipped to respond to her critical condition, and the additional follow-up care that was required.
While New Jersey passed a law last year to prohibit surprise medical bills, the state has no regulatory authority over self-funded plans, often used by large corporations. According to the Kaiser Family Foundation, 61% of Americans are covered by self-funded plans and are not protected by state bans on surprise medical bills.
The STOP Surprise Medical Bills Act closes that gap by prohibiting three scenarios in which surprise medical billing (also known as "balance billing") commonly occurs:
Emergency services: The bill would ensure that a patient is only required to pay the in-network cost-sharing amount required by their health plan for emergency services, regardless of them being treated at an out-of-network facility or by an out-of-network provider.
Non-Emergency services following an emergency service at an out-of-network facility: This bill would protect patients who require additional health care services after receiving emergency care at an out-of-network facility, but cannot be moved without medical transport from the out-of-network facility.
Non-Emergency services performed by an out-of-network provider at an in-network facility: The bill would ensure that patients owe no more than their in-network cost sharing in the case of a non-emergency service that is provided by an out-of-network provider at an in-network facility. Further, patients could not receive a surprise medical bill for services that are ordered by an in-network provider at a provider's office, but are provided by an out-of-network provider, such as out-of-network laboratory or imaging services.
This bill assures the patient is only billed the in-network rate and completely removes them from any further billing fight between their health care provider and insurer. It allows medical providers to be automatically paid the difference between the patient's in-network cost-sharing amount and the median in-network rate for these services. Providers and insurance companies would then have the opportunity to appeal this payment amount through an independent dispute resolution process and arbiter certified by the Secretaries of Health and Human Services and the Department of Labor. The independent arbiter's decision would be based on commercially-reasonable rates for that geographic area and be binding.
"No family in America should have to file for bankruptcy just because they had surgery or were sent to the emergency room," said Sen. Joe Vitale (LD-19), author of the state bill. "Sen. Menendez has been a great partner in Washington. I thank him for his influential leadership and fierce advocacy on behalf of all of New Jerseyans."
"Surprise medical bills burden patients at a time when they should be focusing on recovering from an illness or procedure," said State Senator Teresa Ruiz (LD-29). "Senator Menendez has always championed affordable health care and I'm grateful for his leadership on this front. It's time we put an end to these ridiculous surprise medical bills."
"These unplanned bills are absurd and no family should have to worry about paying them," said Assemblywoman Eliana Pintor-Marin (LD-29). "I appreciate Senator Menendez for always fighting for New Jerseyans and ensuring families are no longer blindsided."
"Surprise medical billing is irresponsible and victimizes hundreds of thousands of patients and their families every year," said NJCA Executive Director Phyllis Salowe-Kaye. "NJCA helped lead the fight to pass state legislation to protect NJ patients against surprise bills. But we need The STOP Surprise Medical Bills Act to finally put an end to this egregious practice and ensure all Americans across the country are protected. NJCA has long supported and protected the rights of consumers across the state and we appreciate having Sen. Menendez as a partner in this important work."
"Even those who provide medical care, like nurses, are hit with surprise medical bills," said HPAE Secretary-Treasurer, Alexis Rean-Walker."Instead of saving for retirement or kids' college, families are forced to scrap together their extra savings to pay for health care. Many health professionals are in ERISA health plans which follow federal, not state regulations. I thank Sen. Menendez for standing up for our nurses so we can ensure that everyone is protected from surprise medical bills, and no family is responsible for an outrageous bill."
The STOP Surprise Medical Bills Act is also cosponsored by Senators Bill Cassidy (R-La.), Michael Bennet (D-Colo.), Todd Young (R-Ind.), Maggie Hassan (D-N.H.), Lisa Murkowski (R-Alaska), Tom Carper (D-Del.), Dan Sullivan (R-Ark.), Sherrod Brown (D-Ohio), Kevin Cramer (R-N.D.), Ben Cardin (D-Md.), John Kennedy (R-La.), Bob Casey (D-Penn.), Joni Ernst (R-Iowa), Sheldon Whitehouse (D-R.I.), Mike Braun (Ind.), Lindsey Graham (R-S.C.), Jacky Rosen (D-Nev.), Cindy Hyde-Smith (R-Miss.), Tina Smith (Minn.), Rob Portman (R-Ohio), Amy Klobuchar (D-Minn.), David Perdue (R-Ga.) and Kyrsten Sinema (D-Ariz.).