April 19, 2016
The law prohibits charges for insured patients with emergency care by out-of-network providers and requires improvements to billing and insurance information on hospitals’ websites.
Florida Gov. Rick Scott signed legislation on Thursday, April 14, that prohibits charges from an out-of-network provider when a patient has covered emergency care or covered nonemergency services. It also establishes a payment process for insurers to provide reimbursement for such out-of-network services.
The Sun Sentinel reports the bill was the result of complaints from patients receiving emergency care at hospitals within their provider network and subsequent bills from doctors working outside of that network.
“This new law protects consumers by holding them harmless in times of both emergency situations when choosing a provider is not an option, and in non-emergency situations when communication may not be made clear regarding out-of-network providers who may be offering care,” said Florida Chief Financial Officer Jeff Atwater in a news release issued after the governor signed the legislation. “As a result, consumers are left with a more affordable bill comparable to what they would have paid if the provider had been in their network.”
According to the bill summary, hospitals are also required to maintain information on their websites to include contact information for practitioners and practice groups contracting with the hospital. It also states the hospitals are required to provide notice that care may be provided by entities that issue separate bills and might not work with the same health insurance companies.
“The bill adds compliance with these new provisions as a condition of licensure for hospitals, surgical centers, and urgent care centers,” it states.
The Florida Collectors Association closely monitored the bill’s progress.
A Kaiser Family Foundation survey released earlier this year shows that bills from out-of-network providers contribute to medical debt problems among insured, non-elderly adults. “Nearly 7 in 10 of individuals with unaffordable out-of-network medical bills did not know the healthcare provider was not in their plan’s network at the time they received care,” according to the survey.
The provisions in the bill signed by the governor should take effect July 1, 2016.