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MSNJ’s Marathon for Out-of-Network Physicians – President’s Message: June 22

By Dr. Mary Campagnolo, MSNJ President

MSNJ is “running a marathon” to protect the rights of out-of-network physicians to continue to provide medical treatment and be adequately compensated. We have actively advocated on this issue for years, not just for physicians, but also to ensure that patients may avail themselves of the benefits for which they have paid dearly.

We have:

  • Stopped a bill that would have criminalized the waiver of deductibles and co-insurance
  • Convinced the sponsor of the pending bill to remove a provision that could have forced facility-based providers to accept any payment offered by an insurer.

To come this far, we have:

  • Testified twice in 2012 and three times in 2011
  • Held dozens of meetings with legislators and stake-holders
  • Participated in a multi-member coalition
  • Provided written testimony on recent amendments to pending legislation.

In the words of John Poole, MD, the Chair of MedAC and JEMPAC and Secretary of AMPAC, on the issue of pending out-of-network legislation, “this is a marathon and we are only at the beginning of the race.”

MSNJ chose to submit written comments to be introduced into testimony on Monday, June 18, before the Assembly Financial Institutions & Insurance Committee on A-2751, legislation that seeks to reform how out-of-network care is delivered and paid for. Our representatives, who were present at the committee, signed-in to oppose the legislation and delivered our written comments on the amendments under consideration that day.  We were able to do so because Monday’s committee amendments were available on June 7 to MSNJ, and the coalition of physician groups which has been advocating on this issue for several years. The amendments were discussed and analyzed extensively during MSNJ’s open-to-the-public Board of Trustees meeting on Sunday, June 10.

MSNJ has been a leader on this issue since its outset, which is why we are recognized by policy makers as one of the most prominent stakeholder representatives in the debate. Our leadership goes far beyond committee testimony.  MSNJ empanelled our own working group of out-of-network providers in early 2010 to provide guidance on this issue. We are part of a multi-member coalition that has actively advocated for out-of-network physicians, in the trenches, for years. We participated in dozens of meetings with legislators and stakeholder groups prior to the initial introduction of this legislation, and worked hard to defeat less favorable bills, such as one that would have criminalized the waiver of co-insurance.  In fact, it was our testimony last month that convinced the sponsor to remove a provision that could have forced facility-based providers to accept any payment offered by an insurer.

We’ve met countless times with our coalition partners, specialty societies, ambulatory facility representatives, and the New Jersey Hospital Association to help foster and preserve a unified provider voice. We delivered our message to the Speaker of the Assembly, Senate President, and Senate and Assembly Minority Leaders more times than anyone can accurately recall.

Our 246 years of advocating for physicians gives us the experience to know that this is not a sprint. The time we’ve spent on this issue gives us the wisdom to recognize that while the bill was improved on Monday, its impact as written remains very much the same and deserving of our continued opposition. Our steadfast leadership on behalf of all physicians continues to give us confidence that the outlier business practices of a small number of out-of-network providers can be addressed in legislation that doesn’t harm the vast majority of physicians who are billing in good faith.

MSNJ has been and will continue to be your voice before the legislature, administration, and the courts on this and all other matters impacting your practice, profession and patients.  We appreciate your faith and support, and look forward to our continued advocacy success together.

Read archived updates on MSNJ’s advocacy efforts on this issue.

NEWS: Out-of-Network Bill Passes Assembly

The New Jersey General Assembly passed A-3378, the so-called Out of Network reform bill, along party lines earlier this week.  While many legislators continued to express concerns over the legislation’s impact on providers, its sponsors, Assemblyman Gary Schaer (D – Passaic) and Assemblywoman Grace Spenser (D – Essex), were able to prevail upon their caucus to get the minimum 41 votes needed for final passage.

The bill, as it stands today, would prohibit the waiver of copays and deductibles with some exceptions, require physicians to discuss their network status and charges with patients prior to the delivery of care, and require insurers to provide information about benefits on their websites.  MSNJ, while agreeing that transparency will ultimately be beneficial to healthcare consumers, is committed to addressing the legislation’s many imperfections as the process moves forward.  The bill has been received in the Senate and referred to the Commerce Committee, which is also considering its Senate counterpart,   S-2372 (Vitale, D – Middlesex).

Click here for the latest version of A-3378.