News & Updates


Insurance Consumer Advocate: Ban balance-billing

The Associated Press

TALLAHASSEE, Fla. — Florida’s Insurance Consumer Advocate said he is trying to find a lawmaker to help him ban a practice that sticks patients with big bills their health plans won’t cover.

Sean Shaw, Florida’s Insurance Consumer Advocate, told Health News Florida that he wants to do away with balance-billing.

“We want to just outlaw it, basically, take the consumer out of the fight between the insurance companies and the health care providers,” Shaw said.

Balance-billing typically occurs when specialists who don’t participate in an insurance network work in a hospital that does. When the insurer pays the specialist its in-network amount, the specialist bills the patient for the rest.

Shaw said it gives patients the choice of paying money that they shouldn’t really owe or getting stuck between the insurer and the physician’s billing clerk.

Shaw is shopping for possible bill sponsors this week as committees meet at the Capitol. But doctors will resist fiercely, said Florida Medical Association’s General Counsel Jeff Scott.

“If Sean Shaw tells me, as an out-of-network physician, that I have to accept (in-network payments), I’d say, ‘I’m not going to see those patients,'” he said.

Shaw said that tells him who cares for the patient and who doesn’t.

He has the backing of the insurance industry, which said it would strengthen networks and protect patients.

“They shouldn’t have to be financially ruined because they have to pay thousands of dollars in balance-bills through no fault of their own,” said Bob Lotane, director of communications for the Florida Association of Insurance and Financial Advisors.

Lotane predicted physicians will fight any such measure as fiercely as they battled insurers last year over Senate Bill 1122, which ordered insurers to pay doctors directly when they treat patients who have chosen to go out of network. Doctors won that fight.

Federal law bars balance-billing of Medicare and Medicaid patients. In Florida, health maintenance organization patients aren’t supposed to be subjected to balance-billing, but state law doesn’t prohibit the practice for those in other kinds of managed-care plans.

Shaw said the law barring balance-billing of HMO patients is widely ignored. In part, it’s because patients and doctors don’t know about the law, and the fine is seldom imposed. That is another thing Shaw said he would like to fix.

He’s stepping into a broadening national dispute.

In January, the California State Supreme Court banned balance-billing entirely. However, doctors have won some battles.

Earlier this year, the American Medical Association and others reached a $350 million settlement with UnitedHealth Group over what the AMA contended were low out-of-network payments. New York Attorney General Andrew Cuomo agreed to work with UnitedHealth to find appropriate out-of-network payment rates.