Gusciora, Muoio & Quijano Bill to Ensure Patients Don’t Have to Pay More for Emergency Care Under New Tiered Plans Advances

An Assembly panel on Monday approved legislation sponsored by Assembly Democrats Reed Gusciora, Elizabeth Maher Muoio and Annette Quijano to ensure that patients will not have to pay more for emergency or urgent care in light of the new tiered health insurance plans that have been rolled out this year.

“This is a paramount concern for residents of Trenton in particular since Horizon Blue Cross Blue Shield rolled out its new tiered health plan that excludes all of Trenton’s hospitals from the lower cost plan,” said Gusciora (D-Mercer/Hunterdon). “Under this bill, if an individual receives care in an emergency room or on an urgent basis, they will not be penalized and charged more due to the network status of the health care facility or the professionals who treat them.”

The bill (A-2585) would require health insurance carriers that offer a tiered health benefits plan to ensure that covered persons who receive medically necessary services on an emergency or urgent basis are not billed in excess of the lowest cost sharing amount applicable to the highest or preferred tier pursuant to the covered person’s health benefits plan.

The sponsors also underscored the importance of the bill for the thousands of state employees who work in Trenton every day and would have to travel all the way to the likes of Princeton for the closest affordable care if a health emergency arose while at work.

“Our primary concern since these plans were unveiled is that residents in certain urban areas like Trenton will have to travel much farther for affordable, emergency care because our hospitals have been shut out of the Tier 1 plan,” said Muoio (D-Mercer/Hunterdon). “This bill will ensure that if someone is seeking urgent cardiac care, for example, they can go to the closest hospital available when time is a priority without being penalized financially.”

A tiered network is a managed care plan provider network with more than one level or tier of in-network benefits, based on different levels of reimbursement and cost sharing accepted by the health care providers in that network.

“Nearly half a million visits were made to Trinitas Hospital last year by Union County residents, the vast majority of whom are from Elizabeth. But under Horizon’s new Omnia plan, Trinitas is not considered a Tier 1 hospital, therefore costs would be higher to seek care here,” said Quijano. “Working families with limited incomes can’t afford thousands of dollars in out-of-pocket expenses if an emergency arises and time is of the essence. This bill will ensure they don’t have to pay more for timely, urgent care.”

Under the bill, if a covered person in a tiered network plan receives medically necessary services on an emergency or urgent basis, the carrier must ensure that the health care facility and health care professional do not bill the covered person in excess of the lowest cost sharing amount applicable to the highest or preferred tier pursuant to the covered person’s health benefits plan.

The bill was approved by the Assembly Regulatory Oversight Committee chaired by Gusciora.