February 18, 2016
TALLAHASSEE — Withdrawn but not forgotten.
Sen. Joe Negron says he will reintroduce an amendment he withdrew on Tuesday to limit health insurance companies from retroactively denying coverage and recouping payment because of unpaid premiums of people who enroll in the federal health insurance exchange.
“I thought I should wait until I had more senators present,” said Negron. "It’s difficult to determine a vote count when so many of the members have competing obligations.”
Negron and lobbyists for physicians, hospitals and insurance companies agree that the outcome of the amendment had a vote been taken was too close to call. And a near collective sigh of relief could be heard in the committee room after Senate Banking and Insurance Committee chairman Sen. Lisbeth Benacquisto announced that the amendment had been withdrawn from the carefully constructed compromise that had been hammered out on balance billing, SB 1442.
Negron told POLITICO Florida that senators support his efforts but he acknowledged that there is sentiment among some that the issue shouldn’t be included in the bill that legislators, HMOs and health care providers hope brings an end to years of legislative battles over balance billing.
“The policy is widely supported — the issue is whether it should be in the balance billing legislation,” Negron said.
Balance billing occurs when a patient sees an out-of-network health care provider. Because they are out of network insurance companies reimburse at non-contracted rates which can be lower. The provider then bills the patient for the difference between what the insurance company reimburses them and what they actually charge.
The insurance, HMO, and hospital industries along with organized medicine have agreed to a bill that would bring balance billing disputes to an end by precluding out-of-network providers from billing insured patients for emergency care. Insurance companies would be required to reimburse non-participating providers the lesser of: the provider’s charges; the usual and customary provider charges for similar services in the community where the services are provided; or the charge mutually agreed to by the HMO and the provider within 60 days of claim submission. The non-participating provider may not collect or attempt to collect any additional amount or balance bill the insured, except for any co-payments or deductibles
Under the agreement insurance companies would be required to include in their policies effective January 2017 language that reads: “Warning: Limited benefits will be paid with nonparticipating providers are used."
Insurance companies also will be required to put on their websites a listing by specialty of the names, addresses, and telephone numbers of all participating providers, including facilities, and, in the case of physicians, must also include board certifications, languages spoken, and any affiliations with participating hospitals. Information posted on the insurer’s website must be updated on at least a calendar-month basis with additions or terminations of providers from the insurer’s network or reported changes in physicians’ hospital affiliations.
The House passed similar legislation, HB 221, on Wednesday.
The balance billing bill heads to the Senate Committee on Appropriations next. Negron said that he plans on offering the amendment to the bill there or even when the bill is heard on the Senate floor.
“I am going to keep fighting to put patients and doctors and nurses and hospitals at the forefront of medicine and not the people who pay the bills,” Negron said, adding that “the issue is not going to go away.”