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Insurance Consumer Advocate

Sha'Ron James


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Bill Takes Aim at Surprise Hospital Bills in Florida

News Article

March 8, 2016

NBC6 Miami

Randy Homyk knew something was wrong when he tried checking his email and it looked like hieroglyphics.

“I couldn't read what was there,” he said of that morning nine years ago. “It was like it was written in Egyptian or something. It didn't make any sense to me.”

After being treated in a Homestead emergency room and at another hospital – both of which were in his insurance company’s network of providers -- something else didn’t make sense: the $20,000 in bills he received after he was diagnosed with mini-strokes and underwent heart surgery to repair the underlying cause.

“The bills started coming and I'm like, ‘Oh my God. I'm going to have a real heart attack this time,’” he said, adding he did not understand why visits to in-network hospitals were producing out of network bills from providers and contractors. “I didn't know who they were from -- this company and that company I never even heard of before.”

Homyk fought his bills and said he wound up paying only the couple thousand in deductibles and co-payments for which he was responsible.

But not everyone subject to so-called “balance billing” has been so successful.

Balance billing occurs when a provider or hospital bills the patient for the difference between what the insurance company covered and what the hospital or provider charges out-of-network patients.

In Tallahassee, the state House passed a bill last week that would protect anyone who goes to an emergency room from being billed out-of-network charges.

But a state senator last week successfully proposed an amendment that supporters say could scuttle the consumer protection legislation now that it must go back to the House with the amended language.

Patients who complain of surprise charges have caught the ear of Gov. Rick Scott.

“I've traveled the state and I've heard stories about the costs to individuals and it’s devastating to their families,” Scott told NBC 6. “It costs way too much and so you should know exactly what the price is so you can make your own decision.”

In an emergency, of course, one may not have time to shop around. But another bill would require clear posting of prices charged by hospitals and providers.

Attorney Steve Weissman, who briefly headed a Hialeah hospital, says the health care pricing system is broken.

“The leading cause of bankruptcy is medical bills and the majority of people who file for bankruptcy have insurance,” said Weissman. “There's just no question the current system is unsustainable.”

Weissman said he never saw any illegal practices at the hospital he led, but believes the entire industry should set and reveal prices that are rooted in reality.

“The answer is to require the health care industry to set real prices just like every other business or industry in the United States,” he said. “It shouldn’t be any different from gas stations being required to post prices.”

A widely publicized study last summer found Florida leads the nation in the number of hospitals gouging patients – that is, charging them far above the prices established by the federal government of Medicaid and Medicare patients.

Repeated requests for comment on these matters from the Florida Medical Association, which lobbies for the medical profession in Tallahassee, have not resulted in any response.