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Insurance Consumer Advocate

Sha'Ron James


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Mailing: 200 East Gaines St.
Tallahassee, FL 32399-0308

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FCEP calls emergent care balance billing 'rare' in resposne to FTC inquiry request

 

Date: December 13, 2016
Source: Beckers Hospital Review
Author:  Brooke Murphy

 

The Florida College of Emergency Physicians called upon state and national legislators to launch an investigation into insurers' reimbursement practices in instances when members receive involuntary out-of-network care.

The message is a direct response to Sen. Bill Nelson's (D-Fla.) letter sent to the Federal Trade Commission earlier this month. Sen. Nelson requested the FTC investigate the practice of "surprise" balance billing caused by involuntary out-of-network care as a violation of federal law.

Specifically, Sen. Nelson pointed to instances of network discrepancies between hospitals and emergency physicians as "unfair and deceptive" business practices.

In a statement issued Dec. 12, FCEP urged Sen. Nelson to investigate insurers' reimbursement practices "before calling for an inquiry into 'surprise bills' by emergency physicians." FCEP said balance bills "result from unwillingness by insurers to contract for fair and reasonable payment to medical providers," rather than profit-hungry emergency physicians.

FCEP conducted an analysis of billing data from Martin Gottlieb & Associates, a medical billing company in Florida. The report showed:

  • About 26 percent of Florida residents had private insurance.
  • Of privately insured patients who received emergency care, 88 percent were treated by in-network physicians.
  • Among the 12 percent who received out-of-network care, the average physician charge was $679. The average insurer payment was $307 and the average patient payment was $49.