Oslo MEDICAL SOCIETY

Proposed regulation  ↔  DOBI

NJ DEPARTMENT OF BANKING AND INSURANCE:  OUT OF NETWORK PROPOSAL
The February 16^th, 2007 deadline to submit comments has been extended until April 2, 2007.

LETTERS SHOULD BE ADDRESSED TO:
MSNJ President Charles Moss, M.D.
Medical Society of New Jersey
2 Princess Road
Lawrenceville, New Jersey 08648-2302

RE:  Proposal Number PRN: 2006-405 (Please include PRN #)

Dear Dr. Moss:

SEND LETTERS VIA FAX OR E-MAIL:
e-mail: (The first letter is L for Lisa Hibbs)
fax:       609.896.0674

MSNJ will deliver your letters to the appropriate officials.  Below are some bullet points that you may want to consider when drafting your letter.  In order for your letter to be considered you must use your own words.

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MSNJ: TALKING POINTS

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The Department of Banking & Insurance (DOBI) has proposed regulations that will increase the amount
that patients pay directly, out-of-pocket, for out-of-network medical care. MSNJ opposes this regulation,
since it will reduce patients’ right to choose their doctor by making out-of-network care too expensive.
It will also cost patients more when an in-network specialist can’t be found. MSNJ believes this proposal
is simply misguided, and we need your help to call for its withdrawal. As we call on our grassroots for
action, we have prepared the following talking points to help educate your patients and peers about this dangerous proposal.

· It will reduce patients’ choice.

The regulation will limit patient choice by making patients pay even more out-of-pocket to go to an
out-of-network physician. Patients will not be able to afford to exercise this choice.

· It will make patients pay even more to see out-of-network physicians.

Patients pay higher premiums in order to get access to out-of-network doctors. This regulation creates a
severe economic barrier to that choice, as the costs shift from the insurance companies to patients.
Patients who need to go out of network for specialized care will delay treatment until they can afford it.
Patients will get very little bang for their premium dollars, while insurance companies rake in even bigger
profits and pay their CEOs huge salaries.

· It does not provide greater transparency on fees.

If transparency is the goal, there needs to be greater access to fee information for patients and physicians
—who don’t even have in-network fee schedules—alike. There should be full and free access to validated
usual and customary fee schedules. Changing to a Medicare fee schedule makes nothing clear. While it is
public, most patients do not know enough about fee schedules and coding to make sense of it. We believe
this change willlead to greater confusion among patients, not more transparency on fees.

· Who benefits? Not patients.

DOBI’s own analysis concludes that this change “. . . will likely have a negative economic impact on covered
persons.” In the same statement, the department admits that “carriers will be positively impacted because
they will pay less . . . .”

Ask yourself, why do this? Who wins?

MSNJ

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On Tuesday, January 9, 2007, MSNJ hosted the first of four meetings to discuss dobi's proposed regulation amendment that will effectively regulate the fees of non-hospital healthcare providers 
can charge their out-of-network patients. The other meeting will be held on January 18, 6:00-8:00 
p.m., at Atrium Country Club, 609 Eagle Rock Avenue, West Orange; on January 24, 6:00-8:00 p.m.,
at msnj headquarters; and on February 7, 6:00-8:00 p.m., at Underwood Memorial Hospital in
Gloucester County. On February 21st MSNJ will hold a fifth meeting, at MSNJ headquarters, at which 
MSNJ will reveal the results of our diplomacy.

For more information, visit the MSNJ website by clicking here.

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