Lagana & Eustace Bill to Require Increased Transparency in Health Care Introduced in Assembly

(38TH DISTRICT) — Legislation Assembly Democrats Joseph Lagana and Timothy Eustace sponsored to require hospitals and other health care facilities to notify patients before providing care that insurance may not cover was introduced recently in the Assembly.

The bill (A-3945) would require in-network health care facilities to inform a patient and obtain his or her consent before permitting an out-of-network health care professional to provide a covered non-emergency service during the patient’s hospitalization or treatment. The measure would also require in-network health care professionals who receive assistance from out-of-network professionals to receive the patient’s consent.

“Patients often visit a hospital for a planned procedure and face hefty charges, because — unbeknownst to them — the doctors or specialists who provided care weren’t in-network. For example, a pregnant woman may go to an in-network hospital for her delivery, but face excessive and unexpected charges because an out-of-network anesthesiologist administers the epidural,” said Lagana (D-Bergen/Passaic). “This legislation advances consumer protection in New Jersey by requiring health care facilities to give people the information they need to make choices that are appropriate for themselves and their families.”

Under the bill, in-network facilities would be required to:

  • Provide a written disclosure form to the covered patient stating the name of any out-of-network health care professional who will provide a covered service; and
  • Obtain a written consent form, signed by the covered person, or a representative thereof, expressly giving the out-of-network professional permission to provide the covered service.

“When someone seeks treatment, it’s generally because he or she has an ailment and wants to be healed. That should be a patient’s focus — not worrying about whether the doctor doing the healing is out-of-network,” said Eustace (D-Bergen/Passaic). “So many patients go to an in-network health care facility with the peace of mind that they’re covered, only to be seen by an out-of-network doctor or specialist they’ve never met and then bombarded with charges they never anticipated. When they know exactly what they’re getting into beforehand, at the very least, those patients who do choose an out-of-network provider may have the opportunity to negotiate fees.”

A health care facility that fails to comply with the bill’s provisions would liable for action by the Department of Health. A health care professional who fails to comply would be liable for action by the appropriate licensing board.