VICTORY!!! Pending Balance Billing Legislation Rejected by the FL Senate Health Regulation Committee
Thursday, January 26, 2011 - VICTORY!!! The Florida Senate Health Committee rejected by a 4-3 vote the proposed PCB 7186. According to FSP (Florida Society of Pathologists), although the House passed a similar bill at committee level, without a Senate companion bill it is highly unlikely that the bill will ultimately pass. Thank you to all physicians that opposed this bill and made the effort to let their representatives know - it mattered!
LAST MINUTE ALERT FROM FSP: Tuesday, January 24, 2012 @ 10:37AM
House Bill 1329 was just put on the agenda for the FL House Health and Human Services Quality Subcommittee for tomorrow, Wednesday, 1/25/2012, at 11:00 a.m. Therefore this legislation will be heard in both the House and the Senate on Wednesday – we need to let the legislators know of our opposition.
We wanted to share the Legislative Alert from the Florida Society of Pathologists with you (below) regarding an upcoming bill which will be heard by the Florida Senate and, if passed, would majorly impact pathologists and other hospital-based physicians. Please be advised that PIMS actively monitors legislation, both in Florida and nationally, which would impact pathologists and/or hospital-based physicians as a whole, and we work diligently to both inform our clients of these issues, as well as work ourselves to contact Senators and Congressmen to make our voices heard on behalf of our clients.
Monday, January 23, 2012 – From FSP (Florida Society of Pathologists)
Now is, most certainly, the time to make your voice heard! FSP adamantly opposes HB 1329 and the proposed committee bill, PCB 7186 (identical to HB 1329), the current “Balanced Billing Legislation” under consideration in the Florida House and Senate this week, on Wednesday, January 25th (11:00 a.m. in the House and 3:30 p.m. in the Senate) in Tallahassee.
Please take a moment to contact the individuals on the list below and urge them NO on PCB 7186—your action is crucial! We have also cut and pasted the Senators’ contact information below for your convenience.
Please contact a member of the PIMS’ Team with any questions or concerns regarding this bill and/or this alert. Thank you!
FSP members are urged to call or e-mail the Senate Health Care Committee and the Representatives on House Health and Human Services Subcommittee:
Chair: Senator Rene Garcia (R)
Vice Chair: Senator Eleanor Sobel (D)
Members: Senator Miguel Diaz de la Portilla (R)
Senator Dennis L. Jones, D.C. (R)
Representatives of the House Health and Human Services Subcomittee:
Chair: Wood, John [R] Chair
Vice Chair: Renuart, Ronald "Doc" [R]
Democratic Ranking Member: Schwartz, Elaine J. [D]
Members: Ahern, Larry [R]
Boyd, Jim [R]
Ford, Clay [R]
Gonzalez, Eduardo "Eddy" [R]
Hudson, Matt [R]
Jones, Mia L. [D]
Nuñez, Jeanette M. [R]
Oliva, Jose R. [R]
Porth, Ari Abraham [D]
Randolph, Scott [D]
Reed, Betty [D]
Rooney, Jr., Patrick [R]
In summary:
- This proposed committee bill (PCB) would unfairly limit the amount of compensation a physician could receive for providing services to a patient enrolled in a preferred provider health insurance plan (PPO) under certain circumstances.
- In cases where a physician provides emergency services and care, mandated by law, to a patient insured by a PPO that the physician does not participate in, this PCB will allow the PPO to pay the physician whatever rate the PPO wants to pay. The physician will have no ability to collect the full amount of his charges
- The PCB also provides that physicians who treat certain PPO patients who voluntarily go out of network for non-emergency services will be prohibited from receiving full compensation for the treatment provided.
- To understand why this is so patently unfair, it is important to understand how a PPO works
- Patients purchase health insurance using the PPO model because this type of plan provides them the flexibility to see whichever physician they choose. The health maintenance organization (HMO) model restricts physician access to a limited network.
- The premiums in a PPO are generally higher than in an HMO. Patients are willing to pay more for the flexibility that PPOs provide.
- In addition to higher premiums, patients understand (or should understand) that they will have to pay more for their care should they choose to go out of network – they are responsible for the portion of the physician’s bill that the insurance company chooses not to pay (they are billed for the “balance”).
- Those physicians who join the PPO network agree to accept a discounted rate in return for having the PPO direct patients to that physician’s practice. In-network physicians can afford to take a lower payment because they get much a much higher volume of patients.
- Requiring an out-of-network physician to accept the in-network rate, or whatever rate the PPO chooses to pay (i.e. a prohibition on “balance billing”) would be extremely unfair to both the patient and the physician.
- A prohibition on balance billing would destroy the distinction between in-network and out-of-network care and would de facto enlist every physician into the managed care company’s network every time the physician chooses to see a PPO patient.
The out-of-network physician is placed on an artificial fee schedule that does not fully cover the cost of providing treatment, without receiving the benefit of increased patient volume. - Patients in the PPO plan will ultimately be the ones to suffer. Physicians outside of the network will simply refuse to see these patients. Patients will lose access to care and will be paying the higher PPO premiums without receiving the benefit of the flexibility in physician access that PPOs are supposed to provide.
The insurance company is the only winner in this scenario. They get to artificially lower their costs and pocket the extra premium.
Please contact the Senate Health Care Committee and let them know that you oppose PCB 7186 as it would not improve a more efficient or cost-effective health care system in our state.
They need to vote “NO”!