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Balance Billing Legislation Pits Consumers, Insurance Agencies Against Healthcare Providers

February 2, 2016 - 5:45pm

The last thing most people think about when heading to the emergency room is how much they’ll end up paying, but the reality of what seems like a quick fix in the emergency room can soon turn into a hefty bill. 

When patients go into a emergency room, they’ll often receive a bill from the hospital for medical care, but after they’re discharged from the hospital, patients will sometimes get “surprise” bills from doctors at the hospital who may have been out of network.

The surprise bill happens when insurance companies and medical providers can’t agree on a charge for a medical service, so the healthcare provider will bill patients for the entire difference.

The practice is called balance billing -- or “extra billing” -- and one state representative wants to put a stop to it once and for all.

Allison Bertucca’s daughter, Ashley, went into the emergency room last January with a migraine. She came into the hospital, saw a doctor, received a shot and was sent on her way. Bertucca told Sunshine State News her daughter was in the hospital for at most half an hour.

Ashley received a bill from the hospital following her stay and began making payments.

Several months later, Ashley received another bill -- this time from the emergency room doctor -- for nearly $1300. Ashley works a $10 an hour job, so paying that bill on top of another hospital bill was problematic.

“They were in there for five minutes and then they left and this doctor charged almost $1300,” Bertucca explained. “She doesn’t have the money. I thought it was really excessive.”

Ashley was covered under her insurance plan’s HMO plan, but insured patients part of a PPO (preferred provider organization) insurance plan can often get slammed by “surprise billing,” leaving patients with thousands of dollars in medical bills.

Rep. Carlos Trujillo, R-Miami, says balance billing is a huge threat to a significant portion of insured Floridians. Insured patients who are members of a PPO  insurance plan are usually the victims of balance billing, and if they’re not able to enter into some a payment plan or pay the bill outright, they could end up filing for consumer bankruptcy. 

Trujillo’s proposal, HB 221, would require hospitals to post information on which insurance plans they accept in the preferred provider network on their websites. Additionally, the bill would advise insured patients the implications of choosing an out-of-network provider. 

Stories of patients who have been charged tens of thousands of dollars have emerged, alarming state lawmakers who say balance billing can bankrupt consumers.

The bill’s Senate counterpart, SB 1442, sponsored by Sen. Rene Garcia, R-Hialeah, narrowly made its way through the Senate health policy committee Monday by a vote of 5-4. The two bills have gathered conflicting opinions from patients, insurance agencies and healthcare providers who each have stakes in the issue. 

Many physicians, hospitals and ambulances are opposed to the bill, saying it could be incredibly costly for them in the long run, and have shifted the blame of the issue onto insurance companies, who they say don’t pay enough of the cost, thus forcing physicians to charge the patient the remainder of the medical fee.

“We have always sought to establish and maintain a completely transparent relationship with our patients,” said David Chapiro of the Florida Society of Ambulatory Surgery Centers.

But other groups disagree and say the balance billing legislation takes the consumer out of the equation, a much needed reprieve for patients who get saddled with the end result.

“This bill takes the consumer out of any disputes that arise about payments,” said Florida Association of Health Plans president Audrey Brown. “It places it between the health plan and the provider which is where it belongs...we believe this bill will encourage insurers to contract with hospitals.”



Reach reporter Allison Nielsen by email at or follow her on Twitter: @AllisonNielsen.


"Tarring & Feathering",.. from the ambulances and Emergency Rooms right on up to the White House ! (That's how Samuel Adams and the Colonists dealt with scoundrels & charlatans...and they built a Country upon that particular version of determining "right from wrong")...

I won't be surprised if the governor vetoes this much needed piece of consumer protection from emergency room doctors who refuse to negotiate with insurance companies because they're aware that the majority of public would rather pay the exorbitant Fees than be dragged to through the mud and ruining their credibility.

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