Surprise medical bills: Senate fight holds bill’s fate

medical billsFriday update: The Florida Senate passed 38-0 its amended version of HB 221 designed to protect consumers against “balance billing” by out-of-network medical providers.

The ball is back is the House’s court.

Final deal coming or a scuttle?

“Based upon the favorable response this bill has received in each committee and ultimately in each chamber, I am hopeful that we will see an end to surprise medical bills in Florida this legislative session,” said state insurance consumer advocate Sha’Ron James.

Thursday update: The Senate has taken up the House bill and adopted an amendment affecting how insurers must pay claims and cover people with disabilities, rolling it to a final vote in the chamber as early as Friday.

Are insurers on board?

“We continue to support the underlying bill as it provides relief for consumers against the practice of surprise billing, and we hope that is what ultimately passes this session,” said Audrey Brown, president of the Florida Association of Health Plans.

How about anesthesiologists? A source with a group representing them said “the amendments are not substantive to our concerns that the bill gives unilateral negotiating leverage to the insurance company.”

Update: In a startling reversal, the Florida Senate removed an amendment adopted earlier in the day that carved out anesthesiologists and radiologists from legislation designed to protect consumers against “balance billing.”

Sen. Latvala said he withdrew the amendment after the chamber began discussing a motion to reconsider the vote. Still, the Negron amendment remains on the Senate bill, meaning the chambers have different versions as the session winds down.

Yes votes for the Latvala amendment included Sens. Jeff Clemens, D-Lake Worth, and Joe Abruzzo, D-Wellington, records show.

Stay tuned for further updates.

Original post: Consumers lost protections against “balance billing” for medical charges Wednesday when The Florida Senate, at the urging of its Stuart-based future president, passed amendments that effectively gutted the bill, its sponsor said.

Among the winners: Radiologists and anesthesiologists, according to sponsor Sen. Rene Garcia, R-Hialeah.

“They hate this bill,” Garcia said on the floor. “They’re the No. 1 abusers.”

One patient advocate called it “a huge loss for Florida consumers.”

A group representing anesthesiologists offered a very different view.

“We’re patients too and we have families,” said Dr. Jonathan Slonin of Sunrise, president of the Florida Society of Anesthesiologists. “The whole balance billing situation is not ideal. We want to find a solution for this and of course part of that solution includes protecting patients.”

But many insurance companies have narrow networks and the proposed legislation “basically gives all the leverage to the insurance companies,” he said.

The House version, HB 221, passed 116-1 Wednesday. It bans consumers from getting surprise charges, sometimes thousands of dollars, in emergencies and other situations where bill supporters say consumers have little control over who provides care.

A prime example in non-emergencies: A consumer goes to a hospital in her insurer’s network. She gets care from someone there offering a particular service — such as anesthesia or radiology — who has not joined the network. The result can be a bill she is not expecting for thousands of dollars. The national advocacy group Consumers Union has called it a “glaring loophole” in Florida law.

Some medical groups argue that despite outlying cases that get plenty of attention, the average “balance bill” is closer to $200.

Heading into Wednesday,  SB 1442 had provisions to cap consumer charges even in some non-emergency situations at the equivalent of in-network costs and force providers and insurers to work out the differences on their own.

An amendment by Sen. Jack Latvala, R-Clearwater, carved anesthesiologists and radiologists out of the bill. It passed 22-16. Latvala argued the bill had strayed from a focus on emergencies.

An amendment by future Senate president Joe Negron, R-Stuart, passed 27-12 to impose a requirement that insurers opposed — to make them pay for procedures they authorize even when consumers fail to pay premiums. Negron characterized it as a consumer-friendly attempt to make insurers “true to their word.”

But the net effect was to change the bill late in the session and destroy a consensus reached by groups often on opposite sides, such as the Florida Medical Association and the Florida Association of Health Plans, bill supporters said. If Negron really wanted to fight for this cause, he could have pursued a separate bill and gone through the committee process, Garcia argued.

“We are disappointed that the amendments added to the Senate bill today complicate the opportunities for consumers to become protected from surprise medical bills in Florida,” said Laura Brennaman, policy and research director for patient advocacy group Florida CHAIN (Community Health Action Information Network).

For example, the bill “exposes consumers to thousands of dollars of balance bills in cases where a patient has no chance to select an in-network anesthesiologist,” she said.

“That is a huge loss for Florida consumers,” Brennaman said. “We commend the House for passing HB 221. We urge the Senate to take up the House bill to protect Florida consumers.”

 

 

 

 

 

 

 

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