Patricia Kelmar
Senior Director, Health Care Campaigns, PIRG
Senior Director, Health Care Campaigns, PIRG
TRENTON, N.J. — NJPIRG Law & Policy Center launched its consumer education campaign Tuesday about how to push back if you receive a surprise medical bill. The campaign includes a tip sheet that offers advice about avoiding and fighting surprise bills before new laws go into effect in January 2022.
Every year, millions of Americans receive surprise medical bills after unknowingly receiving treatment from a provider outside of their insurance network. Studies have shown that nearly one in five emergency room visits and hospital stays results in a surprise out-of-network bill. Although the No Surprises Act, a federal law to protect consumers from surprise medical billing, was passed in December, it does not go into effect for 10 more months. In the meantime, many Americans, including here in New Jersey, are at risk of getting these charges that can cost hundreds or even thousands of dollars.
“No patient should have to pay an expensive surprise medical bill” said William McGovern, the Health Care Campaigns associate with NJPIRG Law and Policy Center. “With the price of health care already rising, it’s more important than ever for consumers to have the right information to identify and fight unfair bills they shouldn’t have to pay.”
The tip sheet explains consumer protections established by a 2018 state law which protects New Jersey residents with state-regulated insurance from having to pay most surprise bills. The law protects patients from surprise bills from an out-of-network provider if there was no in-network provider available. Patients are also protected from out-of-network bills for emergency treatment, even if the emergency room was not in their insurance network.
However, New Jersey law can only go so far. States are prohibited from regulating self-funded plans that fall under the federal Employee Retirement Income Security Act (ERISA). Nationally, 67 percent of workers who have insurance through their employer are in these self-funded,federally regulated plans. New Jersey’s law allows self-funded plans to opt-in to these protections but as of January 2021, only 137 plans had chosen to do so.
“Although New Jersey’s law offers important consumer protections from surprise billing, NJPIRG knew that it could not protect everyone. That’s why we worked to pass a federal solution, the No Surprises Act,” said McGovern. “Thanks to this work, millions more patients will be protected from surprise bills and no insured New Jersey resident will be excluded from these important consumer rights.”
When it goes into effect in January 2022, the No Surprises Act will expand consumer protections to all insured New Jersey residents and extend those protections to consumers who receive out-of-network billing by air ambulances.
To view the tip sheet, please go to https://njpirgcenter.org/resources/njf/how-protect-yourself-surprise-medical-bills-new-jersey or download a pdf here.
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NJPIRG Law & Policy Center is an independent, non-partisan group that works for consumers and the public interest. Through research, public education and outreach, we serve as counterweights to the influence of powerful special interests that threaten our health, safety or well-being.
NJPIRG Law & Policy Center is part of The Public Interest Network, which operates and supports organizations committed to a shared vision of a better world and a strategic approach to social change.