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Insurance Consumer Advocate

Sha'Ron James

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Surprise medical bills: More than emergency care at issue, groups say

News Article

February 17, 2016

Palm Beach Post

Revised legislation that passed its final Florida House committee Wednesday represents a promising development because it helps consumers avoid surprise medical bills in both emergencies and non-emergencies, patient advocates said.

At issue are proposed limits on unexpected charges consumers can face when they encounter medical providers out of their insurer’s network — and have not necessarily made an informed choice to use them. The aim is to limit such charges to the equivalent of in-network fees and leave it to providers and insurers to work out the difference.

The measure heads for the chamber floor as a similar Senate version has one more committee stop.

It deals with emergencies, yes, but also protects insured patients in non-emergency situations when there is “no ability or opportunity to choose an in-network provider,” said Laura Brennaman, policy and research director for the patient advocacy group Florida CHAIN.

She offered an example: A patient goes to an in-network hospital and plans to have a hip replaced by an in-network orthopedic surgeon. The hospital assigns an out of network anesthesiologist and x-rays are read by an out of network radiologist.

Under HB221 and SB1442, “you would also be protected from surprise balance bills from these hospital based providers,” Brennaman said. “We need the protection provided by this fine proposed law.”

Groups often on opposite sides of the debate during the last two years, including the Florida Medical Association and Florida Association of Health Plans, waived comment in support of the measure Wednesday in the House Health and Human Services committee.

“I am thrilled!” said Florida Insurance Consumer Advocate Sha’Ron James.”The amount of collaboration and compromise that has taken place on behalf of Florida consumers is unprecedented.”

James held a workshop on the issue last fall after hearing from consumers and others from Jupiter, Wellington, Boca Raton and around the state.