Members of preferred provider organizations will receive protection from surprise billing by medical providers outside their networks under a new law signed this week by Gov. Rick Scott.
The bill stemmed from complaints by patients who went to hospitals within their networks for emergency care and were then stunned to receive large, unexpected bills from doctors who were not members of the patients’ insurance networks.
The new law extends protections previously in place for HMO members to members of PPOs and exclusive provider plans, or EPOs. It bars patients from being billed for emergency services or covered non-emergency services provided in a hospital or other facility in the patient’s insurance network for any amount that exceeds the co-insurance, co-payment or deductible contracted between the patient and the insurer.
For non-emergency care, hospitals will have to post names and links of all contracted insurers, as well as names and contact information of all practitioners and practice groups under contract with the hospital. Patients will be given statements that services may be provided by out-of-network providers and that they should contact practitioners to determine to which networks they are contracted.
In a statement released Friday, Jeff Atwater, Florida’s chief financial officer, called the bill “an incredibly consumer-friendly piece of legislation.”
“This new law protects consumers by holding them harmless in times of both emergency situations when choosing a provider is not an option, and in non-emergency situations when communication may not be made clear regarding out-of-network providers who may be offering care,” Atwater said.
Because of the new law, consumers will be left with “a more affordable bill comparable to what they would have paid if the provider had been in their network,” he said.
The bill, sponsored by Rep. Carlos Trujillo, R-Miami, and Sen. Rene Garcia, R-Hialeah, overcame strong opposition from anesthesiologists and radiologists.
Debate during the legislative session focused on whether the law would give insurers too much power in negotiations with doctors. One House member worried it would empower insurers not to contract with doctors because it would send disputes into mediation. Emergency room doctors don’t contract with insurers because of low payment rates, he said.
Lawmakers passed the bill after Atwater and the Florida Association of Health Plans pushed for a dispute-resolution process that would require providers and insurers to work out payment issues, leaving patients out of the dispute.
This year’s version of the bill drew support from the Florida Medical Association, which in 2015 warned that doctors would stop taking ER calls if surprise billing was outlawed.
The bill excluded emergency medical transport services, including air ambulances, that are also responsible for large surprise bills. Sha’Ron James, Florida’s insurance consumer advocate, said in an email Friday that federal rules prevented the legislature from including emergency air transportation providers in the bill. But her office is working with other states and members of Congress to address the issue at the federal level.
James said the new law makes Florida “a national leader in holding the consumer harmless” and she hopes it will inspire similar laws in other states.