The Florida Legislature passed (signed by Governor Rick Scott) a bill that may be the most consumer-friendly in the country concerning “Balance Billing.“ Yes—FLORIDA.
Balance Billing was previously illegal in Florida for both Medicare and HMO patients but led to financial havoc for thousands of Floridians with PPO coverage. Simply, a patient who went to an in-network hospital’s emergency room. However, many doctors, although affiliated with the hospital, were not “in-network” for these patients.
The treating emergency room doctor (whom the patient had no option in choosing) submits a “full-price bill say $1,200 to the insurance company. It would cover it’s normal negotiated rate- say $300.
As a result of having no way to choose their doctors, thousands of patients were pursued by medical billing companies (many of which were ruthless about pursuing the patient into collections, negative credit reporting, and sometimes lawsuits). This doesn’t mean that all medical bills will not be vigorously pursued. But they will no longer be pursued as the product of balance billing.
That has changed- Thank you Florida Legislature for “doing the right thing.”
Click here to read Florida Statute 627.64194
All health insurance companies require pre-authorization for certain procedures and hospital admissions. Your physician will submit the necessary clinical information to the insurance company (or third-party company, which many insurance companies utilize to review and determine such requests).
Believe it or not there are times when the Explanation of Benefits (“EOB”) that comes from your health insurer can be your friend when paying your medical bills. Sometimes, it may be difficult to understand the EOB-how much the insurance company is paying, how much you’re paying, how much is written off, ow much is applied toward your deductible, and why. This EOB is a very important sort of statement of account between you and your insurer. You may be able to learn a bit about it on your insurer’s website. This might be a good time to contact a health advocate.
Hello To All:
Everyone that goes to their doctor inevitably gets blood drawn to analyze aspects of their health. It is an integral part of the doctor diagnosing the state of your health. One of our clients (and he is not alone in this) thought that the cost for the lab to process the results were included in the doctor’s bill. WRONG! (more…)