Balance Billing Crackdown Heading Toward Final Votes

Feb 26, 2016

Medical bills
Credit Lauren/flickr.com / https://www.flickr.com/photos/attercop311/

Governor Rick Scott has raised the profile of balanced billing in the healthcare system and now the Florida legislature is trying to tamp down on it. A Senate bill limiting how and when hospitals can charge patients for out-of-network services is on its way to the chamber floor.

If there’s one thing Governor Rick Scott’s hospital and healthcare funding commission did, it was to highlight surprise medical bills. Scott encouraged Floridians to report what he called “price gouging complaints” and it worked. The state held a forum on the issue last October and David Rodgers, a chemistry professor, talked about two bills he received. One was $27,000.

“You can imagine the distress that would cause an entire family which previously thought our insurance was going to protect us, just to find out that wasn’t true," said Rodgers.

These types of bills for services consumers thought were covered, are referred to as balance billing. In Rodgers’ case, the hospital was considered an in-network provider, but the doctor that treated the patient was not.  Early on the House unveiled legislation to crack down on the practice. Here’s Republican Representative John Wood explaining the bill:

“It prohibits balance billing for emergency services and unexpected billing for non-emergency service providers in PPO’s and EPO’s. It provides a formula for insurers to use in reimbursing the non contracted providers in emergency and non-emergency services," he said.

In short, Rodgers may not have gotten a bill under this scenario. The plan is based on recommendations by Florida’s healthcare consumer advocate Sha’ron James. The House measure is up for full consideration by the chamber. Now a bill by Sen. Rene Garcia, R-Hialeah, is a step closer to becoming a law.

“I’ve been asked to try to thread this needle very carefully," Garcia said.  "When we first started no one thought we’d figure this out. We had the HMO’s on one side, the Florida Medical Association on the other side, Florida Hospital Association and other hospital groups on one side. We brought everyone to the table and have come up with a bill everyone can live with.” 

The bill also requires providers and insurers to try and resolve billing issues without patients getting involved. An attempt to include a provision limiting insurance companies from retroactively denying coverage and recouping payments because of unpaid premiums was brought before the committee. Sen. Joe Negron, R-Stuart, says it was a consumer protection.

“The provider, doctor, nurse practitioner or hospital, has a right to rely on the authorization given to them, not only verbally, but with a written authorization code given to them.” 

But Garcia objected, saying the amendment could hurt the larger bill, which is a compromise between the insurance companies, advocates and lawmakers who have worked on the issue for months.

“Sen. Negron, I do agree with the provisions of this amendment but just not on this bill and the way it’s done. I wish it would have been crafted in a separate way that we fix a problem in its entirety," he said.

The issue failed to be added.