Florida legislators have been grappling with the problem of balance billing—also known as “surprise billing”—and now the Center for Medicare and Medicaid Services has proposed a broader rule aimed at fixing the issue.
Balance billing is what happens when a patient goes in for a procedure and gets surprised with a bill because one of the providers or treatments in the process isn’t covered by the insurance company. For example: If someone goes to an in-network hospital for an operation and sees an in-network surgeon, there still might be an out-of-network specialist who has to be consulted while the patient is under anesthesia. Depending on the insurer, that patient can be on the hook for a surprisingly large bill for the out-of-network treatment.
Republican lawmakers in Tallahassee have introduced a bill that would end this practice in emergencies. But the federal proposal would also apply to non-emergency cases.
From the CMS fact sheet on the proposed rule:
We propose that issuers must count the cost sharing charged to the enrollee for certain out-of-network services (provided at an in-network facility) towards the enrollee’s annual limitation on cost sharing. The exception to this requirement would be if the issuer provides 10 days’ notification to the enrollee that an out-of-network provider may be providing these services and that the enrollee may incur additional costs. This proposal aims to limit “surprise bills” to consumers.
“For the institutions, it would require them to do a better job of advanced warning,” says Linda Quick, president of the South Florida Hospital and Healthcare Association. “What they’re trying to do away with is some of these retroactive surprise bills.”
The CMS proposal would apply to plans sold through the Obamacare marketplaces. As Quick points out, it would not apply to Floridians who are insured other ways.
The CMS proposal is currently in the comment period. If it’s adopted, the rule would go into effect in 2017.