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Proposal Targets Cost Of Emergency Transportation For Patients

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

Insured patients in Florida shouldn’t have to pay large bills if they require emergency medical transportation services. They also should have access to copies of their medical records free of charge, a state advisory board agreed Thursday.

Members of the Florida Health Insurance Advisory Board unanimously approved submitting the recommendations to lawmakers for consideration during the 2019 legislative session, which begins in March.

In part, the board is recommending that the Legislature amend the state’s “balance billing” ban to include emergency medical transportation. Balance billing involves situations in which out-of-network medical providers bill patients for amounts above what the patients’ insurers pay.

Current law protects insured patients from being billed by out-of-network emergency care providers such as hospitals and urgent-care centers. It establishes a standard for determining reimbursement rates and authorizes providers and insurers to settle disputed claims under a dispute-resolution process.

The advisory board made a similar recommendation to the Legislature last year about including emergency transportation, but the proposal was rejected.

The panel also agreed to request that the Legislature require health-care providers to give patients one free copy of their medical records, either by electronic mail or traditional mail.

The board only submits recommendations to the Legislature when the proposals have unanimous support. And the recommendations still need to be acted on by lawmakers to take effect.

State Insurance Commissioner David Altmaier, who is chairman of the advisory panel, reminded board members that even rejected proposals can be considered by the Legislature.

“Certainly nothing prohibits you from advocating for those on behalf of your respective organizations,” Altmaier said.

One of the more high-profile recommendations the board considered but rejected Thursday was a proposal to prohibit insurance carriers from amending or removing covered prescription drugs during the policy year. 

Molly McKinstry, a board member who is deputy secretary of the state Agency for Health Care Administration, objected to the proposal because it would impact the Medicaid program. The Medicaid drug formulary is set by a committee that meets quarterly.

“Without Medicaid being excluded …  I would object,” McKinstry said.

The advisory board shot down another pharmacy-related recommendation that would have prohibited insurers from implementing so called “step therapy” programs, which generally require patients to try less-expensive drugs before having access to other drugs that could turn out to be more effective.

Richard Weiss, an advisory board member who is Aetna Florida market president, said insurance companies offer different pharmacy-benefit plans, and price points vary depending on the coverage. Banning insurers from offering policies with step-therapy programs would limit people from buying more-affordable plans, he said.

The board also rejected a recommendation that a standardized prior authorization form be used by providers and insurance plans. Seth Phelps, an advisory board member and Florida Blue attorney, said the insurer had “some concerns from the standpoint of what the details are.”

The board did not consider proposed changes to the state insurance code to allow for the sale of what are known as “association” health plans and new regulations that would allow small employers --- including sole proprietors and people who are self-employed --- to access insurance through the plans. Association health plans --- and the role they will play going forward --- were briefly discussed this week by Gov.-elect Ron DeSantis’ Transition Committee on Health and Wellness.

The board was established in state law to make recommendations to the Florida Office of Insurance Regulation, the Agency for Health Care Administration and the Legislature on health-insurance issues. The board is dominated by insurance-company interests and small businesses but includes a consumer advocate.