Many Canadians snowbirds purchase health insurance while they are in Florida. When a medical issue arises, which must be handled in Florida, the Canadian patient may be shocked that his or her insurance did not cover the costs of the medical services provided. They were not informed that their policy was not accepted by the particular hospital or physician that provided the medical services.
During the 2016 session of the Florida legislature, a law, with the support of both political parties, was passed to protect those that are provided medical services by providers (out of network), who did not accept their insurance policy. The law exempts patients from having to pay balance bills from the out-of-network providers in certain situations. This also applies to patients who go to a healthcare facility in their health plan network and inadvertently receive services from a non-network provider (doctor). Under the new law these patients would only be responsible for paying their usual in-network cost-sharing.
This newspaper will research the exact details of this new law (House Bill No. 221), which amends many provisions of various Florida statutes, in order to advise our readers as to how it might or does affect the medical insurance coverage obtained by Canadians while visiting Florida.
Medical insurance plans and providers (hospital, physicians etc) not participating in an individual’s particular plan would have to work out payment for those services through a state-arranged, voluntary dispute resolution process, which provides for a penalty being assessed against the party that refused to accept an offer that was close to the final arbitration order. The negotiation would be based on the usual and customary rate for the particular geographic area. However, disputes could be taken to court. The bill would only apply to PPO type plans, since HMO plans already have such a law protecting the patients. The purpose of the new law is to protect the individual, who is forced to receive, through no fault of their own, medical care from a provider not covered in their medical insurance plan. The Governor also signed legislation to increase price transparency in Florida hospitals; this is an effort to address the issue of the high costs hospitals pass on to patients and their families. The Republican governor launched his transparency initiative after doing battle last year with Florida hospitals over Medicaid expansion, which hospitals favored and he opposed. Numerous patients have revealed situations where they had to pay hundreds or thousands of dollars in medical bills when they had not known and were not informed that their insurance did not cover being treated by out-of-network providers. As an example, an individual going to the emergency room of a hospital is not informed until after medical services are provided, that his or her insurance policy is not accepted by that hospital. The hospital and the doctors then bill that patient for thousands of dollars for the uninsured services.
Apparently Florida is now far ahead of many other states in this area of protecting medical patients against out-of-network excessive high bills.