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“balance billing”

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Florida House’s ambitious healthcare package

flahouse

The Florida House has passed a healthcare package that, as nicely summarized by The Miami Herald:

  • Sets rules for telemedicine that let out-of-state physicians use technology to serve patients in Florida.
  • Lets  people contract directly with physicians to pay for primary care without involving insurance companies. Those choosing this option would still need to have some  health coverage under the Affordable Care Act.
  • Giving advanced registered nurse practitioners and physicians’ assistants the right to prescribe narcotics and other drugs.
  • Creating new recovery centers that can care for patients for 72 hours after surgery and extending the time  that patients can stay at ambulatory surgical centers to 24 hours.
  • Sets sweeping price-transparency requirements to ease patients’ shopping for non-emergency coverage.
  • Creates new recovery centers that can care for patients for 72 hours after surgery and extends the time patients can stay at ambulatory surgical centers to 24 hours.
  • Seeks to to protect consumers from “balance billing,” in which physicians directly bill patients for services not covered by insurance, which often happens when hospitals contract with outside physicians.


Those ‘balance billing’ blues

 

This Los Angeles Times story tells how patients get very unpleasant surprises when out-of-network costs lurk in in-network hospitals.

Consider those surprise bills from physicians who don’t participate in patients’ health plans but who do practice in hospitals that do. With no contract in place to dictate how much they get paid for services, they can bill patients for charges beyond what insurance covers.

The doctors  charge for the balance of the bill not covered by insurance. It’s  called “balance billing.”

“It’s an abuse of the implicit trust that you have with your doctor and with your healthcare providers,” Gerald Kominski, director of UCLA’s Center for Health Policy Research, complained to the Los Angeles Times.

The paper noted that {f}ederal law doesn’t protect patients from these surprise bills. The Affordable Care Act requires insurers to cover out-of-network emergency services at in-network rates, but it doesn’t stop doctors from balance billing.

And figuring out which doctors participate with which health plans can be easier said than done.

 

 


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