Effective July 1, a change to Florida law will prohibit surprise medical bills for a larger network of consumers.
According to Attorney Eric D. Fader, of Day Pitney LLP in New York City, the law previously protected only consumers in health maintenance organizations (HMOs) from “balance billing.” The change will extend protection to members of preferred providers organizations (PPOs) and exclusive provider organizations, where a predetermined network is in place.
Balance billing refers to the bill a patient receives directly from their healthcare provider if the insurance plan does not cover the balance. The practice is common among “tag-along” providers, like anesthesiologists or radiologists, Fader said.
“This is kind of the flavor of the year for things in health care for consumers to be upset about, with some justification,” Fader said. “Someone goes into surgery—the hospital stay is covered by insurance; the surgeon is covered then you get a bill for $42,000 from the anesthesiologist or someone else.”
By enacting the change and providing protection to a greater number of consumers, Florida joins just a handful of other states with similar billing protection policies, including: New York, Connecticut, and Colorado. But, according to Fader, federal legislation regarding the issue of patient billing protection is certainly not out of the question. A legal movement in favor of patient billing protection would change how hospital and surgeons across the country use ancillary service providers.
“The hospital and surgeon are going to have to take responsibility for who they bring in, who they ask to assist,” Fader said. “For example, a surgical group may have preferred folks they like to work with. If those folks are in network, they might not have worried much if the ancillary providers were in the network.” Fader added, “Now this law will be putting pressure on everyone to be cognizant of such issues.”
In Florida, hospitals will be required to provide patients with information about service providers, if applicable. Insurance companies too will be subject to transparency requirements, making information about providers that are in- or out-of-network more readily available.
As for service providers that are not associated with an insurance network, Fader believes it will become increasingly more difficult to enter a network. “Providers were content to be out-of-network.
Now, there will be more of a push to become part of a network,” Fader explained.
Unlike New York’s billing protection law, Florida’s will not extend “balance billing” protection to patients without insurance. But, Fader believers a very large portion of Floridians will be protected from surprise bills. For more information regarding law changes, [Click Here].