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Insurance Consumer Advocate

Sha'Ron James


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Senate Committee Green Lights Legislation to End Balance Billing

News Article

February 16, 2016

Sunshine State News

Legislation to ban the practice of balance billing continues to weave its way through the Florida Legislature Tuesday, when the Senate Banking and Insurance Committee approved the proposal by a unanimous vote.

The bill, SB 1442,sponsored by Sen. Rene Garcia, R-Hialeah, would ban balance billing for Floridians insured under PPO plans. Around a third of insured Floridians are covered under PPO plans.

When patients go into a emergency room, they’ll often receive a bill from the hospital for medical care, but after they’re discharged from the hospital, patients will sometimes get “surprise” bills from doctors at the hospital who may have been out of network. These bills are usually for the remainder of the balance not paid for by the insurance company.

Balance billing, state lawmakers say, can be quite the problem for consumers since it can often leave them saddled with pricey medical bills -- often to the tune of thousands of dollars -- and consumers can be forced to pay the bill outright or go into consumer bankruptcy.

“The consumer, at the end of the day, is getting dinged or getting a bill where they never expected when that when they are going to a par facility,” Sen. Garcia explained to committee members Tuesday.

“You walk into a hospital thinking you’re completely covered and when you walk out of that hospital you’re getting a bill from your anesthesiologist or your radiologist because they don’t have a contract with that managed care entity,” he continued. 'We’re trying to prevent that from happening.”

Garcia’s legislation has already won the support of health insurance companies, who say the bill is key for consumer protection.

“Floridians who have preferred provider organization (PPO) health plans, which is more than half of the state’s consumers, are often being overwhelmed when hit with surprise medical bills, also known as balance billing – a practice where health care providers bill consumers for the balance of the retail charges for medical services after various payments to the health care providers are made,” said Audrey Brown, President and CEO of the Florida Association of Health Plans.

“Fortunately for Florida consumers, relief is in sight thanks to the hard work of Senator Garcia, who has worked tirelessly to bring all parties to the table to reform this system and institute common sense public policy that ends the often devastating practice of PPO balance billing for Florida consumers,” Brown continued, expressing gratitude to the Senate committee for passing the legislation.

Banning balance billing is also a top priority for Chief Financial Officer Jeff Atwater, who has said he’d support legislation forcing insurance companies to pay for claims even if the patient has sought treatment from an out-of-network provider in an emergency situation.

"Over time, public policy has put us in a place where the consumer is getting a raw deal," Atwater said.

The House companion bill, HB 221, sponsored by Sen. Carlos Trujillo, R-Miami, had difficulty passing through the legislature last year, but has fared better in its respective committees during this year’s legislative session. The House Health & Human Services Committee will hear Trujillo’s bill Wednesday, which is the last stop it will make before heading to the House floor for a full vote.

The Senate bill now heads to the Senate Appropriations Committee.