Health And Accident Insurance New Jersey

NJ Hospital Accused of Price Gouging

$90,000 for a knee arthroscopy. $67,715 for a steroid injection. $161,510 for a plasma back injection.

Those are just some of the exorbitant fees that insurance companies claim a for-profit northern New Jersey hospital is charging for providing auto accident victims with outpatient care, according to a report published in Newark, N.J.'s Star-Ledger on Monday.

The hospital in question - Meadowlands Hospital Medical Center in Secaucus - is run by outpatient surgery center operators, having been purchased by 3 nearby centers in December: Essex Surgery Center in Hackensack, Roseland Surgery Center in Roseland and Bergen Ambulatory Surgery Center in Saddle Brook. It is charging as much as 3,000% more than the ASCs charge for the same treatments, according to the report, which alleges that the ASCs have been referring auto accident victims from their facilities to the hospital to take advantage of a fee loophole. New Jersey limits what ASCs may charge, but it doesn't regulate what hospitals may charge for most outpatient care.

To close this billing loophole, state insurance officials have proposed capping what hospitals can bill for 2,000 never-before-regulated outpatient procedures. In a letter, hospital officials have asked the governor to "join us in opposing any effort to impose ambulatory surgical rates on all services performed at hospitals." Surgery centers, the letter continues, "do not share a fraction of the costs of operating a hospital and are not burdened with charity care. Paying hospitals and (ambulatory surgery centers) at the same rate is simply unfair.

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Many small business owners are confused over recent legislation and may be concerned about how the Health Care Reform Act will affect them and their employees. For small businesses and self-employed individuals, health insurance costs are already a high percentage of their overall expenses, and many are rightfully concerned about how recent legislation may affect them.

To help self-employed individuals, small business owners, and their employees navigate the confusing language and conflicting information related to recent health care legislation, we have provided the following answers to frequently asked questions. For additional information, visit (related SBBS blog post links)

Affects of Health Care Reform on Small Businesses:

Some insurers are changing their areas and/or types of coverage. If you have not yet heard from your Agent regarding changes that may be occurring as early as January 2011, you should request notification of any coverage changes.

Health Savings Accounts (HSA’s) have reduced coverage for over-the-counter medication and supplies. Request a copy of changes to your HSA, and review with employees.

Insurers will likely be making many changes to premium levels, coverage, requirements, deductibles, co-payments, and other terms of service over the next year or two as legislation continues to evolve. Now is the time to review your existing policies and options with a professional Health Insurance Broker, and make changes as needed.

The bottom line is that while we don’t yet know the full effects of Health Care Reform on insurance options and costs, we do know that the legislation has created a moving target of changes in the industry. Now is the time to review needs and policies, and to meet with a qualified Health Insurance Broker to navigate these changes and help you to make the best decisions for your business and your employees.

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