News & Updates


Insurer: Bill will increase costs


Published: May 20, 2009

TALLAHASSEE – Blue Cross Blue Shield has joined with consumer and union groups to urge Gov. Charlie Crist to veto legislation they claim will inflate health care costs.

The bill, from Sen. Don Gaetz, R-Niceville, would make it easier for doctors to get payment from insurers without joining their preferred provider organizations. House and Senate lawmakers passed the bill by wide margins this spring.

A PPO insurer typically reimburses out-of-network physicians at the reduced rate it pays for in-network care, leaving patients to cover the balance. Currently, the insurer pays the patient, from whom doctors must try to collect the full amount.

The "hassle factor" of pursuing payments, said Jeff Scott, legal and government affairs director for the Florida Medical Association, detracts from time and resources spent on patients. Gaetz’s bill would force insurers to pay out-of-network doctors directly, if authorized by the patient.

Opponents – including Blue Cross and Blue Shield of Florida, Consumer Federation of the Southeast, Florida PIRG and Associated Industries of Florida – say that could up-end the PPO system and leave consumers holding the bill.

That’s because direct payment is an incentive for physicians to join PPO networks, according to the critics. Gaetz’s bill, they say, would make it easier for doctors to leave networks, forcing consumers to seek more out-of-network care at greater expense. Doctors remaining in PPOs would have leverage to argue for higher rates.

Doug Martin, lobbyist for the American Federation of State, County and Municipal Employees, worries about the "financial blowback" for the state’s insurance program. "The state’s financial experts expect this to have a large financial impact."

The Department of Management Services predicted this spring the proposal could cost the state insurance program up to $18.5 million in 2010-11. Costs to employees could rise 75 percent, DMS concluded, relying on data from an actuarial firm and Blue Cross Blue Shield, third-party administrator for the insurance group.

Gaetz did not respond to requests for comment.

Scott charged that Blue Cross Blue Shield has "muddied" the issue. Doctors will not leave PPOs, Scott said, because the patient volume they provide is too valuable.

Crist has not yet received the bill, but has already received more than 350 letters and e-mails about it. Crist spokesman Sterling Ivey said the governor has not yet voiced an opinion.

Reporter Catherine Dolinski can be reached at (850) 222-8382.