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Sha'Ron James


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New Florida Law Protects Patients from Surprise Out-of-Network Bills

 

Date: June 09, 2016
Source: Heartlander Magazine
Author:  Marcus Rech

 

Florida Gov. Rick Scott (R) has signed legislation protecting patients from receiving bills with higher-than-expected charges from providers outside their insurance networks.

House Bill 221 prohibits out-of-network providers from “balance billing,” the practice of billing a patient for the amount the patient’s insurance company did not reimburse the provider. The legislation passed the Senate 39–0 and the House 118–1 on March 11 and will take effect on July 1.

The new law also requires hospitals to list on their websites all health insurers and health maintenance organizations (HMOs) with which the hospital contracts as a network provider. Similarly, insurers must post online and update monthly the contact information for each health care provider in their networks.

Hospitals must also post online a statement advising patients to contact individual health care practitioners to determine their network affiliation, because practitioners do not necessarily participate in the same insurance or HMO network as the hospital where they provide care.

Increasing Price Transparency

Sal Nuzzo, vice president of policy at the James Madison Institute, says the law suggests lawmakers were attentive to constituents’ and patients’ needs.

“Legislators were presented with a number of cases where individuals obtaining emergency care were facing thousands of dollars in unanticipated medical bills, even though they thought that the service provider was in-network,” Nuzzo said.

The new law is part of a concerted effort in the state to increase health care price transparency for patients, Nuzzo says.

“In addition to the balance billing legislation, the governor signed [HB 1175,] requiring the Agency for Health Care Administration to establish an online database that will provide pricing structures for health care services,” Nuzzo says. “This is another step forward in providing greater transparency and information to patients.”

Lone Dissenter

State Rep. John Tobia (R-Melbourne Beach) was the only lawmaker in either chamber to vote against HB 221, which also requires health insurance plans and HMO contracts to cover treatment of individuals with Down syndrome.

Tobia, who initially voted for the bill on March 2, says he voted against it on March 11 to protect small businesses from additional government mandates, especially those attached as riders to unrelated legislation, as the Down syndrome mandate was.

“With more than 50 mandates on health insurance in the State of Florida, HB 221 adds yet another,” Tobia told Health Care News. “The Down syndrome mandate will continue to increase the cost of health care when the Legislature should be focused on free-market solutions to lower costs.”