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Insurance Consumer Advocate

Sha'Ron James


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Mailing: 200 East Gaines St.
Tallahassee, FL 32399-0308

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Advocate welcomes 'great start' for ban on surprise bills, doctors wary

News Article

January 19, 2016

Palm Beach Post

A bill designed to prevent Florida consumers from getting hammered with surprise emergency medical bills cleared an early legislative hurdle Tuesday.

Supporters applauded, but in a battle with a long way to go, some doctors warned it is the wrong prescription for them and patients.

Under legislation filed in Tallahassee, consumers would be “held harmless” in emergency situations, paying no more than the equivalent of in-network.

“I think it was a great start,” said Florida insurance consumer advocate Sha’Ron James. Proposals she backed afterhearing from consumers in Palm Beach County and around the statewere adopted 12-0 in an amended HB 221by the Florida House subcommittee on banking and insurance.

The problem the bill aims to fix: Unexpected, sometimes huge bills when consumers are treated by doctors or other providers not in their health plan’s network. In one Jupiter case, for example, a patient was billed more than $23,000 for trauma services.

Such cases may be settled eventually, but the burden is squarely on consumers. In emergencies especially, patients typically have few realistic options to shop around or check who is in network, yet may face wiped-out savings, bankruptcy or ruined credit.

Attempts to resolve the issue stalled in the legislature last year.

Under the bill, consumers would be “held harmless” in emergency situations, paying no more than the equivalent of in-network charges. Insurers and non-network providers would be required to work out differences in binding arbitration if necessary — but they could not simply make it the consumer’s problem.

Groups representing doctors, radiologists and others expressed sympathy for patients caught in the middle, but warned the bill could backfire.

“I think this bill will actually be detrimental to the patients of Florida,” said Jason Goldman, the Florida chapter governor for the American College of Physicians. “We make it even more difficult to be reimbursed. We’re not going to get specialists to see patients when we need them in the emergency setting.”

The Florida Association of Health Plans, representing insurers, supported the bill.

“This bill takes the consumer out of any disputes that arise about payments,” president Audrey Brown said. “It places it between the health plan and the provider where it belongs.”

But medical groups argued the bill tilts the field too much in favor of insurers, handing them too much power to determine “reasonable” charges before cases go to arbitration.

Rep. David Santiago, R-Deltona, questioned arbitration costs. He understood many disputes involve differences as small as $300, but the parties would have to split arbitration costs that can start around $800.

One option he and others raised: Ban “balance billing” for consumers but don’t over-prescribe a cure for payment disputes.

Insurance subcommittee chair John Wood, R-Winter Haven, said it is possible a simpler version of the bill could emerge.

“The consumer has to be protected,” Wood said. “There’s not dispute about that.”

A Senate version, SB 1442, awaits its first hearing in the 60-day session that began this month.