Hospital, Insurer Clash Over Payment Information

May 5, 2016

In a battle between a major Jacksonville hospital and State Farm Mutual Automobile Insurance, the Florida Supreme Court on Wednesday grappled with questions about how much information the hospital should be required to disclose about its charges for care.

State Farm has sought copies of contracts between Shands Jacksonville Medical Center and health insurers, arguing that the contracts could help show whether State Farm is paying reasonable amounts when the hospital treats people injured in auto accidents. But the hospital, now known as UF Health Jacksonville, fought the request and won last year at the 1st District Court of Appeal.

Alan Nisberg, an attorney for State Farm, told the Supreme Court the insurer can't find out whether it is being billed reasonable amounts unless it has the information held by the hospital. The dispute stemmed from care provided to 29 State Farm customers with personal-injury protection, or PIP, auto coverage.

"The issue here is reasonableness of charges,'' Nisberg said.

Hospitals and health insurers enter into contracts that include varying charges and discounts, at least in part because health insurers can provide a steady flow of patients to hospitals. Shands Jacksonville attorney John Tucker drew a distinction between those contracts and the hospital's dealings with State Farm, whose customers show up in emergency rooms after accidents.

"Blue Cross is not the same thing as State Farm," Tucker said, referring to the state's largest health insurer. "Blue Cross brings people to our hospital."

A circuit judge sided with State Farm in the case, ordering the hospital to turn over contracts with 37 health insurers. But the 1st District Court of Appeal overturned that decision, spurring State Farm to ask the Supreme Court to resolve the issue.

Justices, who typically take months before ruling in such cases, asked numerous questions Wednesday as they delved into complicated issues such as hospital charges and the state's PIP insurance law.

"What does cost mean?" Justice Charles Canady asked Tucker at one point. "Does it mean billed charge?"

Justices Peggy Quince and Barbara Pariente, meanwhile, noted that State Farm paid the 29 claims involved in the case before going to court to try to get the hospital's contracts with health insurers. Tucker said auto insurers can decline to pay bills or pay only portions of bills if they question the reasonableness of charges. Ultimately, such disputes can be resolved in lawsuits.

Hospital charges have been a high-profile issue in Florida during the past year, as Gov. Rick Scott has repeatedly argued that hospitals are not transparent enough --- even going so far as to accuse the industry of "price gouging." The industry has vehemently disputed the accusation. Lawmakers this year approved a measure that supporters said will improve transparency for patients about hospital prices and quality.