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Insurance Chief Pushes Patient Billing Change

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Nothing is going to slow down Insurance Commissioner David Altmaier from asking the Florida Legislature to prevent insured patients from being hit with high out-of-pocket costs for emergency medical transportation.
Not even pending recommendations from Florida Insurance Consumer Advocate Sha'Ron James, who a year ago assembled a working group on emergency medical transportation to study the problem and recommend solutions.

Altmaier this week shepherded through the Florida Health Insurance Advisory Board a recommendation to ban what is known as “balance billing” for emergency medical transportation, despite concerns from several board members. Altmaier chairs the advisory board, with seven of the board members agreeing to approve the legislative recommendation.

Four board members who had concerns about approving the recommendation were advised that they could abstain from voting instead of opposing the measure.

“I think the reason a special work group was put together to look at this is because it is a complex issue,” board member Molly McKinstry, a deputy secretary at the state Agency for Health Care Administration, said, referring to James' group.

McKinstry stressed that she is not opposed to the concept of balance-billing protections but said that it would be “premature” to vote on the Altmaier-backed recommendation without hearing from James' panel first.

The Florida Health Insurance Advisory Board is a panel charged with making recommendations to the Legislature on how to improve the state's health insurance market.

The balance-billing ban is the only legislative recommendation approved by the board for the 2018 session, which starts in January. But it's a recommendation that could help give Altmaier's boss — Gov. Rick Scott — a consumer friendly health-care issue to use if he campaigns against U.S. Sen. Bill Nelson, D-Fla., next year.

Advisory board member and Florida Blue attorney Mark McGowan had concerns with the recommendation, but his problems were more substantive.

Lawmakers in 2016 approved a balance-billing law that prohibits out-of-network providers from balance billing customers of preferred-provider organizations (PPOs) or exclusive-provider organization (EPOs) for emergency services or for nonemergency services when the nonemergency services are provided in a network hospital and the patient had no ability and opportunity to choose a network provider.

The law also establishes standards for determining reimbursement to the providers and authorizes providers and insurers to settle disputed claims under a dispute-resolution program.

That situation isn't ideal in a town where there only is one emergency air-transportation provider, McGowan said. He expressed concern that, in attempting to fix the problem of insured customers getting hit with high bills, the state could create a situation that essentially forces insurance companies to pay whatever providers bill.

“There needs to be some sort of customary and usual charges figured out,” he said.

When McGowan asked if the advisory board would have an opportunity to revisit the issue after the vote, Altmaier suggested that the chances were slim. He said he wanted to have the recommendations finalized and in the hands of lawmakers when they hold their first round of interim committee meetings in October.

James told The News Service of Florida on Friday that she created her working group in October 2016 and planned to wrap up its meetings by October 2017. Her office would then spend the rest of the year analyzing data it had been given and listening to the testimony that was presented before finalizing recommendations by the end of the year.

“There's no question there should be protections, the challenge is how they are applied,” she said.

James said it was appropriate for Altmaier, the top insurance regulator, to be aggressive on the issue and didn't fault him for making the recommendation without her group's work.

But Jeff See, who serves on James' working group, disagrees.

“Any separate legislative recommendation in advance of the forthcoming plan from the working group is preemptive and sidesteps the group's work over the past year to ensure fair coverage for beneficiaries who find themselves in dire circumstances in unforeseen emergencies,” he said in an email to the News Service.