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Insurers Rail Against Transparency

Fraser Cobbe

Orange County Medical Society

Seminole County Medical Society

Earlier this week the Florida Association of Health Plans issued a statement using scare tactics to call for the defeat of a measure that seeks simple fairness and transparency. House Bill 217, and its companion bill, Senate Bill 162, is an attempt to level the playing field and provide greater transparency in the delivery of health care within a "grace period."

Current Florida Law establishes a grace period of 30 days where a patient has health insurance coverage in effect even though they may fall delinquent in paying their insurance premiums. If the patient fails to pay the premium after 30 days the insurance contract is void and the insurance carrier can deny services rendered during that grace period. If the patient pays the premium balance owed then the insurance coverage remains intact.

It is understandable that neither the insurance company nor the physician want to be saddled with the bad debt for services rendered during the grace period. The reason for the proposed legislation is that the statutes currently favor insurance carriers on this issue and place all of that financial risk on the shoulders of physicians.

To complicate matters, the Florida Office of Insurance Regulation has stated that insurance carriers are prohibited from telling physicians that their patient is in the grace period and therefore reimbursement for services rendered could be in jeopardy.

We agree that no one should be left carrying the burden of increased debt in this scenario and believe that the proposed legislation will provide transparency and hold patients accountable for their role in solving this issue.

By removing the "gag clause" insurers can tell physicians that the patient is in the grace period and armed with that knowledge, physicians can make the decision whether to delay non-emergent treatment until that time that the patient reinstates coverage.

If the insurance company tells the physician that the patient is in the grace period, they would maintain their ability to deny coverage if the physician proceeds with treatment and the patient does not pay their premium.

This legislation eliminates the hot potato bad debt scenario between insurers and doctors and holds patients accountable to make a decision to catch up on their premiums if they want insurance coverage to pay for the medical services they need.

We call upon the insurance companies to stand up for transparency and patient accountability and urge the Legislature to take action on this good legislation.

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