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Sha'Ron James


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Insurance company must fairly reimburse emergency physicians

News Article

March 11, 2016

Tallahassee Democrat

 

A long-simmering problem for some Florida patients and their insurance companies –”balance billing” – has caught the attention of Florida legislators.

Balance billing occurs when patients receive bills for medical services not covered by their health plans. These bills result from a patient’s increasing share of responsibility under growing numbers of unaffordable high deductible health plans being offered by insurers.

Balance bills also are generated because insurance companies frequently and arbitrarily determine maximum allowable charges for emergency services, and underpay providers for emergency services rendered.

Insurance companies have a historical pattern of manipulating data for the benefit of their shareholders and, ultimately, for their bottom line. As insurance companies have searched for ways to cut costs and boost or maintain profits, these companies are increasingly shifting health care costs to patients, who often do not fully understand their responsibility or are ill prepared to shoulder the burden of these additional costs. This predatory profiting comes at the peril of their customers’ financial well being and the financial viability of Florida’s health care safety net.

Insurance companies are sometimes unwilling to contract in good faith with health care providers. As a result, emergency physicians and physician groups are forced into out of network status with these health plans.

Florida’s legislative body wants to ban balance billing to protect patients. The Florida College of Emergency Physicians will support this meaningful legislation, but vehemently opposes such a ban if there are no provisions requiring insurers to fairly reimburse physicians for emergency care.

We understand “fair reimbursement” is a contentious issue between insurers and physicians. As such, we advocate using the FAIR Health database to help ensure healthcare cost transparency. FAIR Health, which is a national, independent, nonprofit corporation, uses its database of billions of billed medical and dental services to help consumers plan or estimate health care costs.

Our heath system also needs to invest in a fair alternative dispute resolution process to resolve instances where health insurance companies reimburse providers less than what is reasonable and expected. The resolution process should have enough regulatory power to hold insurers accountable should they continue to consistently underpay for emergency care services rendered.

Florida’s emergency physicians provide a vital service to residents. We are the only medical providers readily available 24/7, 365 days a year for anyone seeking care. As the core of Florida’s health care safety net, emergency physicians provide more uncompensated and under-compensated care than any other provider group. While insurance companies will promptly cancel health care coverage if customers cannot pay, emergency physicians are dutifully obligated to provide high quality care regardless of the consumers’ ability to pay.

With fair and transparent payment provisions, an acceptable system to determine reasonable charges and reimbursement, and an even-handed dispute resolution process, the FCEP and the physicians we represent will embrace a ban on “balance billing.”