November 16, 2015, Patricia Lee, a partner in Connell Foley's commercial litigation and health-care groups and Matthew Baker an associate in the firm's litigation group recently co-authored "Transparency in Out-of-Network Reimbursements: Can It Reduce Health-Care Costs in NJ?" published in New Jersey Law Journal.
Rising health-care costs in the United States have been a "hot button" issue for more than a decade. New Jersey is ranked one of the highest states for premiums and out-of-pocket costs, and is home to some of the most expensive hospitals in the world.
One of the core controversies, both in the marketplace and the legal arena, is "out-of-network" billing. Seemingly every week there is a news report about an individual receiving a "surprise" medical bill from an out-of-network provider, charging thousands of dollars for what appears to be a routine procedure. As more providers have left networks to be free of lower, contracted reimbursements, the difference between the amount an out-of-network provider charges a patient for a particular procedure and the amount that the patient's insurance plan will cover has grown more divided.
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