Far too often medical bills overwhelm families when they’re hit with surprise bills as a result of unexpected emergencies, even families that have purchased health insurance.
The practice of balance billing for emergency services has been detrimental to many, but relief could be on the way thanks to state Rep. Carlos Trujillo. The Miami Republican has filed House Bill 221, which would effectively end the practice of balance billing PPO policyholders who receive emergency medical care from out-of-network health care providers.
Specifically, the proposal would prohibit hospital emergency departments and providers from billing a consumer the balance difference between the retail charges for emergency health care and what the provider receives in payment from the consumer’s copayment or co-insurance and reimbursement from the consumer’s insurer.
Some have recently claimed that portions of Representative Trujillo’s legislation are lifted straight from the pages of the Affordable Care Act (ACA), also known as “Obamacare.” That’s a misrepresentation. The ACA does not prohibit PPO balance billing of consumers or prohibit any form of balance billing for out-of-network services, which is the purpose of Representative Trujillo’s proposal.
Without passage of Representative Trujillo’s HB 221, Floridians with PPO health insurance policies will continue to be balance billed for out-of-network emergency services. Florida law now prohibits balance billing of out-of-network emergency services for patients with HMO health care policies, and those protections were in place long before the ACA came into existence.
Florida’s Insurance Consumer Advocate recently held a forum focused on surprise balance bills. At that hearing the Consumer Advocate illustrated the real-life effects of PPO balance billing. A Boca Raton woman was diagnosed with a brain tumor and was told that she needed emergency surgery. She went to her in-network hospital for the procedure and was unknowingly treated by an out-of-network neurosurgeon at that hospital, resulting in her receiving a balance bill that totaled $81,890 from the out-of-network neurosurgeon as a surprise bill.
Balance billing is a serious issue that’s not only unfair, but can bankrupt a family.
At the Florida Association of Health Plans, and on behalf of our PPO policyholders, we fully support Representative Trujillo’s bill aimed at ending the practice of PPO balance billing for emergency services.
We urge the Florida Legislature to adopt this consumer-friendly bill.
Audrey Brown is the president and chief executive officer of the Florida Association of Health Plans. Column courtesy of Context Florida.