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Sha'Ron James

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Florida Implements Law Protecting Consumers From Surprise Medical Bills

News Article

April 14, 2016



Florida is now the second state behind New York to shield consumers from expensive surprise medical bills, as Governor Rick Scott today signed into law legislation that would protect patients from balance-billing in both emergency and non-emergency hospital situations.

The measure, introduced last fall and passed by the state’s legislature last month, aims to put a stop to unfair and unexpected out-of-network charges that affect nearly 30% of privately insured Americans.

Many surprise medical bills result from a practice dubbed “balance-billing.” This is when out-of-network healthcare providers — surgeons, anesthesiologists, technical specialists, ER doctors, and ambulance services, among others — bill patients for the amount that remains after the insurance company only pays part of the invoice.

Florida already bars HMO networks from balance-billing, and the new law extends that protection toconsumers of PPO and EPO plans.

Under the bill, doctors and hospitals are prohibited from sending patients out-of-network medical bills for visits to the emergency room and other healthcare facilities if they don’t have the ability or opportunity to be treated by a participating provider.

That means that doctors and hospitals that don’t have a contract with the patient’s insurance plan can not balance-bill a consumer.

Instead of sticking patients with the expensive bills, insurance companies and the non-participating provider or facility is required to reach an agreement on a fair payment for services through a state-arranged, voluntary dispute resolution process.

When the parties reach an agreement, they would then be bound by that rate for future medical service disagreements.

Our colleagues at Consumers Union, who are running a campaign to end surprise medical bills and worked with local groups on the Florida bill, applauded the law.

“This new law is one of the most comprehensive approaches in the nation to protect consumers from surprise medical bills,” Betsy Imholz, Special Projects Director for Consumers Union, said in a statement. “We heard from thousands of Floridians stuck with surprise out-of-network bills, many worth thousands of dollars. In the wake of an emergency situation or hospitalization, the last thing that consumers should have to worry about is struggling to pay a bill for being treated by a doctor they had no choice in.”