Health Care & Prescription Drugs News

TALLAHASSEE, Fla. – A bill pending in the Florida Legislature would increase health care costs for patients across the state, Florida’s leading consumer advocates warned today.

Florida PIRG, the Consumer Federation of the Southeast and the Florida Alliance for Retired Americans warned that the one-page bill, (SB 1122/ HB 855), will undermine PPO networks in Florida and increase health care costs for Florida patients and small businesses.

“This bill may be small, but it’s going to be bad for consumers and really serves no other purpose other than to drive up health care costs,” said Brad Ashwell of Florida PIRG. “We believe this legislation would raise costs system-wide by undermining the ability of insurers to negotiate reasonable fees with physicians, causing higher insurance rates and higher out-of-pocket medical bills for Florida patients.”

According to an actuarial study of the bill provided by Blue Cross/Blue Shield of Florida and reviewed by Oliver Wyman, an actuarial consultant used by the State of Florida, the legislation could increase the 2009 cost of the State of Florida Employee Group health insurance plan by $22 million – a burden state taxpayers would pay. Public employees also would face an increase of about $118 million in their share of health care costs.

Today, health insurers contract with credentialed doctors to create a “network” of doctors who have agreed to reasonable rates for providing medical care. Members of PPO insurance plans are encouraged to visit these doctors to take advantage of lower rates. This works for patients because they don’t have to pay bills (except for co-payments and deductibles) to their in-network doctors, who are instead paid by the insurance company.

But if SB 1122/ HB 855 becomes law, doctors who are not members of PPO networks – and have not agreed to reasonable rates for medical care – will be entitled to receive direct payment from a patient’s insurance company in the same way as a doctor who is a network member. Moreover, the law will allow them to bill the patient for the difference between their higher rate and the lower PPO rate. This change would put patients at the mercy of high medical bills, collections agencies and even lawsuits.

“These bills will raise insurance premiums and out-of-pocket health costs for retirees not yet eligible for Medicare – for the sole purpose of benefiting doctors at the expense of patients,” said Richard Polangin of the Florida Alliance for Retired Americans. “In these tough times when everyone is struggling to make ends meet, raising health care costs beyond their current very high level is exactly the wrong prescription – it is not what the doctor should order.”

The consumer advocates said they were opposed to the legislation as written because it could punish consumers with costly and unexpected medical bills, as well as undermine current incentives for doctors to charge lower rates for medical procedures.

“This bill as written is a prescription for a disaster for FloridaWalter Dartland, executive director of the Consumer Federation of the Southeast. “Patients who go to a doctor for medical care and are hit by unexpected bills could see their credit damaged, their families dogged by collections agencies and even become victims of lawsuits.” patients and taxpayers,” said

Dartland said that if the Legislature did choose to move forward with the legislation, it is vital that lawmakers amend the bill to protect Florida patients in the following ways:

Transparency and Consumer Disclosure

• When a patient goes to an out-of-network doctor, the doctor should be required to provide an “Out of Network Consumer Disclosure.”

• This disclosure should clearly state that the doctor is not part of the patient’s PPO network and that the patient will be responsible for paying any costs over the amount the PPO will pay the doctor.

• The doctor should disclose and furnish a reasonable explanation of additional fees for which the patient will be responsible, over and above any payment from the PPO plan.

Define reasonable charges

• Florida should define the “reasonable charges” an out-of-network doctor can bill a patient.  Doctors should not be able to charge out-of-network patients significantly more than the average rate they charge to other patients. 

Debt collection

• Florida should include protection for consumers to ensure that difficulties paying medical bills do not negative impact their credit rating. 

• Especially in this current economic climate, it is unfair for Florida patients struggling to pay medical bills to suffer damage to their credit – which could affect their auto insurance rates, mortgage and credit rates, as well as their ability to secure housing and jobs.

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