March 25, 2016
Cape Coral Deaily Breeze
A patient protection bill described by an array of proponents as a model for states across the country was awaiting the signature of Gov. Rick Scott at press time.
Dubbed the "End Surprise Medical Bills" legislation, the House and Senate passed the measure that would protect insured patients receiving medical services in Florida from unexpected charges known in the health care industry as "balance billing" by eliminating the practice. Balance billing allows physicians outside of a patient's PPO network to bill them the out-of-network rate remaining after the insurance company kicks in its share, even if the hospital or admitting physician is within the patient's insurance plan.
Patients in HMO plans already have billing protections in an emergency. The legislation awaiting Gov. Scott's signature would expand that protection to those with PPO plans, which are the most common type of health insurance option selected.
The state has received numerous complaints from patients treated in emergency rooms across the state, as well as patients admitted for planned surgeries, who were not aware that they might be treated - and billed - by physicians who are not network providers. The "surprise" bills have often been in the tens of thousands of dollars, according to the Florida Insurance Consumer Advocate's office, which supports the legislation sponsored by Sen. Rene Garcia and Rep. Carlos Trujillo.
"I applaud the Florida Legislature for passing legislation that bans balance billing. The impact this legislation will have on Florida's families is tremendous," said Florida Insurance Consumer Advocate Sha'Ron James, whose office noticed consumers of what it calls a "medical billing problem" late last year.
Florida's Chief Financial Officer, Jeff Atwater, has taken a similar view.
"The Florida Legislature was tasked with striking a finely-tuned and balanced solution to a multifaceted problem," said CFO Atwater in a prepared statement. "While all sides of this health care community presented valid perspectives and strong opinions throughout the legislative process, I'm pleased that our legislative leaders kept consumers at the forefront of this conversation, ultimately removing them from this complex billing equation.
"This solution holds consumers harmless in times of emergency and in non-emergency situations where consumers have little or no choice who their provider is, resulting in the consumer's responsibility being comparable to what they would have paid had the provider been in their network," he added. "Additionally, consumers will receive more notice and transparency from both insurance companies and providers. This will help consumers navigate the complexities of health insurance billing. This legislation is a win for every Florida family - both those that have experienced balance billing in the past and those that thankfully will not have to."
While Lee Memorial Health System officials say patients using its hospitals are not affected by balance billing issues, we agree with those urging Gov. Scott to sign the legislation into law - as do two sometimes-at-odds industry organizations, the Florida Association of Health Plans and the Florida Medical Association.
If Gov. Scott signs the bill before the paper hits the streets Friday, we applaud him. If not, we urge Gov. Scott to sign the legislation.
A medical emergency, or the need to schedule a surgical procedure, is unpleasant surprise enough.
Patients responsible enough to pay often-hefty insurance premiums should not get a second such surprise - after-the-fact sticker shock - in the wake of a health care calamity.
- Breeze editorial