1. Cost Containment and Accountability Act
Out-of-Network Consumer Protection, Transparency,
Cost Containment and Accountability Act
The Fight To Protect
New Jersey Consumers

2. Existing NJ Protections
Members in: - Large group - Individual - Small group plans - State Health Benefit Plan Are held harmless for the balance of any out of network charges in emergency situations.

3. SO WHAT’S THE PROBLEM?

4. THE NJ SOLUTION Creating a Comprehensive Consumer Protection Bill

5. PRINCIPLES ESSENTIAL TO ANY SOLUTION
Hold Consumers Harmless for any “inadvertent” out-of-network charge
In-network cost sharing will apply for “inadvertent” charges
Require providers to disclose network status and estimated cost of care
Ban balance billing of consumers for emergency and inadvertent out-of-network charges
Notify consumers of the ban and how to report violations
Remove consumers from the dispute
Establish an independent dispute resolution process for providers and payers to resolve disputed charges
Expanding protections to ERISA plan members (opt-in)

6. Navigating the Landmines
Political and Regional Divides: North v. South
Push back from powerful stakeholders
Building consensus through a unified coalition
Emphasizing consumer protection and cost savings

7. THE PROCESS POLICY PUBLIC MESSAGING
Stakeholder meetings with bill sponsors
Building a coalition of diverse allies
Engaging outside experts and national partners
Lobbying legislators
Sounding the alarm
Mobilizing partners & consumers
Story collection
Galvanizing media attention

8. Surprise Medical Bills
What they are and how to stop them, while ensuring access to needed services and adequate payment to providers
Educating policy makers on the problem, its impact and the solution needed in order to truly protect consumers.
Combining research with reality – stories of real consumers impacted all across NJ
A REPORT BY

9. SOUNDING THE ALARM ON COST

10. “Surprise out-of-network med bills cost NJ $1B”
Michael Diamond, Asbury Park Press, June 16, 2016
“Report: Out-of-network care drives premiums in N.J. up by nearly $200”
Lindy Washburn, The Record, June 16, 2016

11. Story Collection
"I honestly felt sick to my stomach," Ambos said. "I know I have a co-pay but I never thought in a million years that taking my daughter for an emergency room visit would cost me $3,251 when I was in network.“
Asbury Park Press, June 16, 2016

12. COALITION OF SUPPORTERS
New Jersey Appleseed Public Interest Law Center
New Jersey Citizen Action
New Jersey Firefighters' Mutual Benevolent Association
New Jersey Policy Perspective
New Jersey State Pipe Trades Association
New Jersey State Policemen's Benevolent Association, Inc.
New Jersey Public Health Institute
NJ Association of Mental Health & Addiction Agencies, Inc.
NJ Business & Industry Association
NJ Superior Officers Association
NJEA
Professional Firefighters Association of NJ
Rutgers AAUP-AFT
State Trooper Fraternal Association
South Jersey NOW, the Alice Paul Chapter
State Troopers Fraternal Association
Statewide Parent Advocacy Network
Union of Rutgers Administrators 
AARP – NJ
AAUP Biomedical & Health Sciences of NJ
AFSCME New Jersey AFL-CIO
AFT Local 1904, Montclair State University
AFT New Jersey
American Federation of Teachers
Anti-Poverty Network
Association of Counties-NJ
Consumers Union
Council of New Jersey State College Locals
CWA District 1
CWA Local 1014
CWA Local 1081
CWA New Jersey Area (Local 1032)
Employers Association of New Jersey
Faith in New Jersey
Family Voices
HPAE
Local 1766
National Association of Social Workers – NJ
National Multiple Sclerosis Society, New Jersey Chapters
National Patient Advocate Foundation
New Jersey AFL-CIO
42 Groups in total - Leveraging the support and influence of these groups to move the legislative process and build support

13. The Power of National Partners
The Facts on Out-Of-Network Surprise Bills
“To put it in very, very blunt terms:
This is the health equivalent of a carjacking.”
Zack Cooper, Assistant Prof., Health Policy & Economics, Yale University

14. New Jersey Consumers and Pass Cost Containment and Accountability Act
The Fight To Protect
New Jersey Consumers and Pass
A1952/S1285
The Out-of-Network Consumer Protection, Transparency,
Cost Containment and Accountability Act
CONTINUES…..
Maura Collinsgru Health Care Program Director New Jersey Citizen Action