Anesthesiologists Criticize 'Surprise Bill' Proposal

Nov 15, 2015

A recent story on 'surprise bills' by Health News Florida's Carol Gentry hit the nail on the head.

A growing number of insurance plans known as “preferred provider organizations” (PPOs) are leaving far too many patients without the coverage they need for emergency medical services.

These ever-narrowing plans were sold as a reasonable, lower cost alternative to an HMO or other broader plan, but by design reduce the insurance companies’ costs by including less doctors in their networks. When emergency care is provided by a physician not in one of these so-called “skinny” networks, the carriers simply refuse to pay the physician or hospital a reasonable fee for that service.  In some cases, merely because they hold all the cards, the insurer refuses to pay anything.

This gives the physicians or hospitals providing the service no choice but to turn to the patient for payment.  This creates an awful situation for everyone involved, resulting in a costly surprise bill for patients and an awkward situation for those docs who provided care when it was most needed.   

A very disturbing epilogue toGentry’s story is being written right now in Tallahassee, as some of our state’s lawmakers are considering a bill that will make this scenario even worse.

To solve the problem of out-of-network insurance coverage gaps, HB 221 looks to the Affordable Care Act (Obamacare) for its solution.  Lifting an entire Obamacare section nearly word for word, HB 221 puts even more power into the hands of insurance companies.  Like the federal healthcare regulation, this bill puts into law a legalized price-setting scheme that allows PPO’s and insurance companies to pay unfairly low rates for services that their customers have received.   

Florida’s physician anesthesiologists recognize the problems the current scenario causes patients and their families.  We also believe that doctors who provide emergency services should not be forced to ask patients to pay for care but should be able to negotiate on evenhanded terms with insurers.

We are willing to work with lawmakers to repair HB 221 and put a system in place where patients are not handed surprise bills and both doctors and hospitals are paid an equitable and balanced fee for life-saving medical care.

Dr. Jay Epstein of Clearwater is an anesthesiologist who is board certified in anesthesiology and critical-care medicine. He is past-president of the Florida Society of Anesthesiologists.  He can be reached at jhe@tampabay.rr.com.