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Sha'Ron James

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Surprise medical bills: Consumers 'need help' from lawmakers now

News Article

February 29, 2016

Palm Beach Post

Joyce Trapp said it was frightening enough that her husband, a law enforcement officer decorated for valor, suffered a brain injury in a motorcycle accident. Then came the unexpected bills.

The Loxahatchee couple had to pay more than $10,000 out of pocket, though they had insurance, she said. On top of that, collection notices began arriving. One was for $4,524. Another was for $2,377.

“I was thinking, ‘Oh my God. How am I going to pay this?’ ” she said.

This week, state legislators can pull Florida consumers from the middle of disputes between insurers and medical providers who are out of their networks, patient advocates say. They can end surprise medical bills in situations where the patient has no choice about who provides care.

On the Florida House floor, lawmakers could take up HB 221 as early as today. It is designed to limit consumer charges to the equivalent of in-network co-pays and deductibles in emergencies and other cases with restricted consumer choice. The aim is to hold consumers harmless and put the burden on out-of-network providers and health plans to work out differences on the proper payment amounts.

Joyce and Jeff Trapp said collection notices arrived at their Loxahatchee home even though they had insurance.

The full Senate could consider its version Wednesday. Less than a week ago, a tense committee fight over an amendment to SB 1442 — backed by a future Florida Senate president with roots in Palm Beach County and the Treasure Coast — led some advocates to fear the bill could be scuttled.

The national group Consumers Union warned Monday in emails to Floridians about amendments on the floor that could “derail this good bill.”

An attempt to resolve this issue failed a year ago under a withering crossfire of lobbying by powerful interest groups on different sides.

Jeff Trapp (left) won an award for valor before his 2013 motorcyle accident. (Bruce R. Bennett/The Palm Beach Post)

Some doctors have expressed concern insurance plans could gain too much leverage under proposed changes and wind up being required to pay too little for patient care.

“We provide amazing care in the emergency department,” said Todd Slesinger, an emergency physician who lives in Boca Raton and is a member of the Florida College of Emergency Physicians. “The fear in emergency medicine is, if someone can dicate payment at a rate you know is unsustainable, what do you do?”

Some medical groups encourage legislators to consider a multi-state database of price information called FAIR Health to help resolve disputes, rather than sources they view as created or controlled by insurance companies. Separate bills before lawmakers now would address some of those issues.

Patient advocates, meanwhile, have tried to keep the focus on holding consumers harmless. Many view getting the legislation to the House and Senate floors as a hopeful sign.

“We are very optimistic that the bill will pass the floor in both chambers — and the consumers of Florida will have a great victory,” said Laura Brennaman. She is policy and research director for the advocacy group Florida CHAIN (Community Health Action Information Network).

If a consumer knowingly chooses an out-of-network provider for a certain price, there’s no problem, advocates say. The trouble comes when the consumer has insurance and is trying to be responsible, but gets blindsided by surprise charges. These can run into the thousands or even tens of thousands of dollars.

The practice is sometimes called “balance billing.” It affects up to one in three consumers nationally, according to surveys. Some bills might be eventually settled, but the process puts ordinary people at risk of wiped-out savings, bankruptcy or ruined credit.

That’s why the push is on for protection in emergencies and certain other cases — a non-network radiologist, say, at an in-network hospital — where it is difficult or impossible for the consumer to shop around.

Thursday, an amendment by future Senate president Joe Negron, R-Stuart, would have required insurers to pay for certain medical procedures they authorized even if consumers stop paying premiums.

“This does protect consumers,” Negron told the Senate appropriations committee.

The amendment was initially declared to have passed on voice vote in the committee, but a roll call vote reversed that verdict.

Insurance groups including the Florida Association of Health Plans indicated they opposed the amendment but did not explain their position in the hearing. Sponsor Sen. Rene Garcia, R-Hialeah, said he advised them not to speak in the interests of conserving time.

In a statement to The Palm Beach Post later, the Florida Association of Health Plans said, “Under the proposed amendment an individual could receive three months of free health insurance coverage every year and never have to pay a premium.” That could eventually drive up health costs for all policyholders, the group argued.

“Sen. Negron’s amendment was consumer friendly, but it was packaged in a manner that threatened the balanced support by the insurance industry and the health provider community for the main issue of eliminating surprise medical bills,” Brennaman said.

Groups who have often been on opposite sides of the debate, such as the Florida Medical Association and the Florida Association of Health Plans, have indicated support for the core bill. Still, not every corner of the medical community is necessarily thrilled, including some specialist groups who maintain they could be forced to accept less than fair compensation.

Ambulance services were removed from the bill earlier this session, a concession to improve chances of passage.

“I believe we have a very good chance of passing a comprehensive ban on balance billing, which is what we set out to accomplish,” said Florida Insurance Consumer Advocate Sha’Ron James.

Jeff Trapp, 58, said he is now retired as a police officer with the Veteran’s Administration. In his home this past week, he pointed to a photo that shows him receiving a valor award. It was for helping to subdue an armed man, he said. That was before his motorcyle accident in December 2013.

When he awoke from a medically induced coma, he said, some called him Mr. Miracle. He and his wife were grateful for the care he received. He continues to struggle with the effects of the crash, but has made progress. As he recovered, he said could hear his wife talking on the phone about the bills.

“I knew things were not good when she told me she had to sell the horses,” he said, referring to the rescue horses they both loved. “I knew she wasn’t telling me everything, but I could see how many people she was talking to on the phone. There was nothing I could do.”

This week, Joyce Trapp said, there is something Florida legislators can do.

“We need help as consumers,” she said.