Insurance lobby pulls knives out for ‘retroactive denial of claims’ bill

insurance

An attempt in the Florida House to scale back legislation targeting retroactive denials of medical insurance claims hasn’t exactly mollified the insurance lobby.

A string of lobbyists representing health carriers testified during a recent committee hearing against HB 217 by Boca Raton Republican Bill Hager, notwithstanding an amendment restricting its provisions to policy grace periods — generally, the 30 days when a policy is in effect but the policyholder might not yet have paid the premium.

SB 162 would forbid the practice at any time.

Insurers would have to verity a patient’s eligibility at the time of treatment. The idea is to prevent carriers from giving the OK to treatment and then demanding repayment from the policyholder or treatment provider.

Asked during the hearing before the Health Innovation Subcommittee why he proposed the amendment, Hager was straightforward: “Because I want the bill to pass.”

Efforts to ban the practice go back years and, in the past, the insurance industry has worked with legislative sponsors. Paul Sanford, representing Florida Blue and the Florida Insurance Council, told the panel that his organization has not done so this year.

The committee approved the amendment and passed the bill, which still faces tests before the Appropriations and Health & Human Services committees.

The Affordable Care Act — or “Obamacare” — featured prominently in the discussion. Critics warned that Hager’s bill would enshrine in Florida law language similar to ACA regulations against retroactive denials.

“If this bill becomes law, you will have codified one of the ACA’s most controversial provisions — the idea of free health insurance,” said Wences Troncoso, general counsel of the Florida Association of Health Plans. In effect, he said, consumers could acquire 30 days of free health care per year.

“This is an expansion of Obamacare here in the state of Florida,” said Brewster Bevis of Associated Industries of Florida, which has made killing the legislation a top priority.

Miami Democrat Nicholas Duran found it a bit much.

“It makes me scratch my head how quickly we use the words ‘Obamacare’ and ‘ACA’ and boom — this thing’s already poisoned,” Duran said.

The bill eventually received two ‘no’ votes, from Jacksonville Republicans Jason Fischer and Clay Yarborough.

Fischer, for example, argued the measure would let people “legally defraud a system and allow someone to get their claims paid but not actually pay their bill.”

Mark Dobbertien of the Florida Medical Association said the amended bill still would represent “a small step forward,” but “would significantly limit the scope of the bill to a small subset of claims. In a large majority of instances, the insurers would still be able to retroactively deny that claim.”

“If an insurance company makes a promise, it should keep the promise,” Hager said.

Michael Moline

Michael Moline is a former assistant managing editor of The National Law Journal and managing editor of the San Francisco Daily Journal. Previously, he reported on politics and the courts in Tallahassee for United Press International. He is a graduate of Florida State University, where he served as editor of the Florida Flambeau. His family’s roots in Jackson County date back many generations.



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