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Sha'Ron James


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Legislature working to stop insurance company practice of 'balance billing'

News Article

February 26, 2016

Sun Sentinel

Who is in your corner when you or a family member is sick or injured?

Emergency physicians provide direct care 24 hours a day, 365 days per year while coordinating access to the entire hospital resources and additional specialty care. It is not only our privilege to provide that care, but we are the only medical specialty under federal and state laws that mandate that we provide care to all regardless of a patient's ability to pay.

Is this true of health care insurance companies in Florida who raised your premiums an average 9.5 percent this year? Is it true of health care insurance companies who are cost shifting to you?

Cost shifting occurs when you have a high deductible health care insurance plan, a narrow network of providers, high deductible costs for prescription medications or lack of appropriate coverage for out of network providers for needed or specialty care. This cost shifting goes by many names. "Balance billing" refers to the difference between the fair market cost of providing a medical service and the underpayment of those costs by the insurance company. The difference is then billed to the patient instead of the insurance company. The "surprise" to the patient is that they were not covered by their policy. This unexpected bill contributes to medical debt.

In a medical study, "Medical Bankruptcy in the United States, 2007: Results of a National Study," found that medical debt was the primary cause of personal bankruptcy. "For insured people, the gap between insurance coverage and the affordability of health care manifests as medical debt that … can lead to an array of personal and financial problems including having to go without food and heat plus a reluctance to seek further medical treatment."

It is in this context that we appreciate the finding of the New York State Attorney General reporting on their HealthCare Industry Task force study in 2009. "If consumers do not understand how they will be reimbursed out of network, or if insurers promise more than they deliver or make unintelligible promises, it is the consumer who suffers because it is the consumer who gets stuck with the bill. This frequently leads to unexpected debt, bad credit, and, in many cases, bankruptcy."

TheFlorida Legislature has heard about the fear of medical debt from constituents and is attempting to pass legislation on transparency and eliminate balance billing without consideration of the potential consequences — the collapse of an underfunded or non-funded emergency care provider system and specialty provider network in Florida that is taking care of more than 6.8 million patients today. The FAIR Health organization was founded to help ensure health care cost transparency without direct influence from insurance companies. This is the standard for reimbursement that we want to be measured against. A standard free of manipulation from insurance companies and an appropriate dispute resolution process is something we can all support.

Can the legislature deliver this for the 20 million people of Florida and protect our high quality emergency care system?

Dr. Andrew I. Bern is an emergency physician in Fort Lauderdale and is on the board of the Florida College of Emergency Physicians.