March 18, 2016
Columbia Journalism Review
Florida legislators have sent Gov. Rick Scott a bill to prohibit doctors and hospitals from hitting patients with out-of-network medical bills for visits to the emergency room and for services at covered hospitals and other healthcare facilities — creating one of the strongest consumer protections of its kind in the nation, according to advocates.
“It is among the strongest and most comprehensive bills in the country,” said Chuck Bell, program director for Consumers Union, the nonprofit policy and advocacy arm of Consumer Reports magazine. “It’s really a good model.”
The legislation, if it becomes law, would protect consumers from receiving surprise medical bills from doctors and hospitals that don’t have a contract with the patient’s insurance plan, an increasingly common practice known as “balance billing.”
However, Florida’s bill excludes one type of healthcare provider: private ambulances and municipal emergency medical transport services, whose rates are set on the county level.
Florida’s proposal faced stiff resistance from some physician groups and others. Opponents argued that the legislation would undermine the power of physicians, particularly hospital-based doctors, to negotiate fair payment for their services.
Florida Rep. Carlos Trujillo, a Miami Republican who sponsored the bill in the House, said state lawmakers were able to build consensus in part by establishing a way to resolve disputes “that most of them can live with.”
Unlike some other states, Florida’s proposal against surprise medical bills includes a prescription for hospitals, doctors and insurance plans to reach agreement on a fair payment for services, Trujillo said. The process includes the opportunity for a mediator to decide what defines a fair payment.
Once a fair payment is agreed upon by all parties, Trujillo said, hospitals, doctors and insurance plans would be bound by that rate for that medical service in future disagreements.
“Our number one goal,” Trujillo said, “was to remove the consumer from the middle. ... For the most part, hospitals, insurance plans and physicians realized the merit of the issue.”
Rep. Carlos Trujillo of Miami
Josh Young, an emergency room doctor and representative for the Florida College of Emergency Physicians, said the dispute resolution language is still a bit vague. But he agreed on the need to remove patients from the process.
“Our goal is just to be able to maintain a fair payment,” he said, “so we can continue to offer quality emergency care to those who need it.”
Florida law already prohibits balance billing — but only for members of a health maintenance organization, or HMO, and only for emergencies and covered services provided in an in-network facility. The bill adopted this year by legislators extends those protections to consumers with preferred provider organization (PPO) and exclusive provider organization (EPO) plans.
Florida legislators passed the bill March 11, giving the governor 15 calendar days to either sign or veto the bill. If Scott takes no action, then the bill automatically becomes law.
Scott’s office did not respond to a request for comment on the bill. But Trujillo said “I can’t imagine a scenario” in which the governor would veto the bill.
“It’s a great piece of consumer protection legislation,” he said.