Out Of Network Medical Bills Becomes A Major Cause Of Concern For Patients

High ‘out of network’ medical billing by the hospitals has been a big issue for quite a few days. In the latest set of events, the healthcare stakeholders have testified their version during the second hearing on the issue about the high medical bills. One of the points raised by the hospitals and healthcare providers is that they do not receive sufficient reimbursement from the commercial payers and government and is one of the reasons why some payers decline to negotiate lower rates.


 On the other hand, the consumer advocates say that the high charges are a big burden to the families and they are being forced to pay a large sum of their medical bills. The Assembly Financial Institutions and Insurance Committee, which is hearing the case is headed by Craig J. Coughlin. The first two hearings held were aimed at devising a legislative to tackle the out-of-network medical billing issue. 


Out of network medical billing issue has been a major cause of concern as many for-profit healthcare systems have taken over hospitals. According to Jean Pierce, who is a member of public policy health staff of Health Professionals and Allied Employees said that there are many hospitals in the Hudson County that follow an out of network business mode. 


Pierce says, “In the long run, financial transparency is critical to ensure consumer protections. Hospitals should be required to publicly disclose their financial documents, as not-for-profits are required to do; and, in addition, should establish an all-payer claims database, which would be developed and maintained by the state.”  She further adds that hospitals “should be required to disclose to patients whether they are in or out of network, what charges the patient may incur during their care and whether they have the ability to choose another provider who is in network.”


The financial security of the patient is very important. Therefore, she says, “The goal of the Affordable Care Act was to increase the number of patients with insurance coverage, while setting parameters for health care facilities to improve the quality of care. Yet, if the current situation continues, any advances in expanding coverage may be for naught if an increasing number of providers choose and prefer to remain out of network.” 


Some of the experts in the industry believe that it is important to have a legislation about the out of network medical billing issue, as some hospitals might move out of this network once they are acquired by a for-profit healthcare company.  Let us hope that legislation would soon be passed in this regard.