The movement to protect consumers from surprise medical bills won a major victory last week when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations.
The new law will apply to patients who go to a healthcare facility in their health plan network and inadvertently receive services from a non-network provider. Patients would be responsible for paying only their usual in-network cost-sharing.
Plans and nonparticipating providers would have to work out payment for those services through a state-arranged, voluntary dispute resolution process, with a penalty assessed to the party that refused to accept an offer that was close to the final arbitration order. The negotiation would be based on the usual and customary rate for the particular geographic area. Disputes could be taken to court. The bill would apply only to PPO-type plans, since Florida already bars balance-billing patients in HMOs.
Consumer groups were delighted. “We commend Gov. Scott for signing HB 221 to protect Floridians from unfair medical bills,” said Laura Brennaman, policy director for the Florida Community Health Action Information Network. “With the law signed today, consumers who are forced through no fault of their own to receive care from an out-of-network physician will be protected from surprise balance bills.”
Scott also signed accompanying legislation to increase price transparency in Florida hospitals. “This legislation is an important first step as we continue to address the high costs hospitals pass on to patients and their families,” Scott said in a written statement. The governor launched his transparency initiative after doing battle last year with Florida hospitals over Medicaid expansion, which hospitals favored and he opposed.