Physician Practice

States take action against out-of-network bills

Physician Practice Insider, November 29, 2016

With out-of-network bills becoming a bigger problem, some states are passing laws that make it more difficult for providers to charge patients out-of-network rates.

In April, Florida became the latest state to limit the scope of surprise medical bills when it approved House Bill (HB) 221, which prohibits patients treated at in-network hospitals from being charged out-of-network costs for care even if they’re treated by an out-of-network provider. The bill also protects consumers from out-of-network charges at emergency departments in the state.

HB 221 also created a dispute resolution process for physicians and insurers to settle disputed claims. Under the process, the amount of an offer made by a physician to settle an alleged underpayment by the health insurer must be greater than 110% of the payment amount the physician received. And an offer made by the health insurer to settle an alleged overpayment to the physician must be less than 90% of the alleged overpayment amount by the health insurer.

The bill was supported by the Florida Association of Health Plans and the Florida Medical Association, which opposed a similar bill in 2015 over concerns that it discouraged some physicians from taking emergency calls.

This article was originally published in Physician Practice Perspectives. Subscribers can read the full article in the September 2016 issue.

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