Florida joins a host of states including New York and Texas that have enacted legislation shielding patients against the high cost of out-of-network claims. Prior to this legislation, only HMO subscribers were protected from out-of-network (OON) balance billing. The new legislation (HB 221) broadens these protections to both emergency and non-emergent hospital services. These protections include advance notice, greater transparency, and an independent process to resolve disputes between payors and providers.
The new law prohibits OON billing in emergency situations for all types of insurance products, including preferred provider organizations (PPOs). The new law also protects consumers when they are at in-network hospitals for non-emergency services, but are unknowingly treated by out-of-network physicians for covered services. The law requires that insurers “are solely liable for the payment of fees” minus any applicable cost-sharing amounts and prohibits out-of-network providers from balance billing patients. It also requires increased transparency and notice to consumers about the possibility of being treated by an out-of-network practitioner. Hospitals must post on their websites their in-network health plans and put consumers on notice that they may be seen by out-of-network practitioners.
Florida’s new law further strengthens the dispute resolution process for health plans and medical providers to resolve payment issues. It encourages non-participating providers to charge, and health plans to offer, reasonable amounts prior to beginning the dispute resolution process. If the dispute resolution process is initiated, the law requires the dispute resolution organization to be transparent and publish the evidence or data the organization used to make its findings.
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