Emergency room physicians in Florida are calling a new state law that bans surprise medical charges "flawed," according to a WJCT report.
The law effectively bans balance billing, which has been a hot topic at both state and national levels.
The practice of balance billing refers to a physician's ability to bill the patient for an outstanding balance after the insurance company submits its portion of the bill. Out-of-network physicians, not bound by contractual, in-network rate agreements, may bill patients for the entire remaining balance.
Balance billing leaves patients with unanticipated medical bills that can have detrimental financial effects.
But emergency room physicians in Florida said the law — under which consumers cannot be charged more than the equivalent of in-network charges in emergencies and at other times where the patient has no real choice — is lacking, according to the report.
When the law takes effect in July, physicians will have to settle reimbursement issues through arbitration with insurance companies. But Steven Kailes, MD, president of the Florida College of Emergency Room Physicians, asked: Who decides what charges are reasonable?
Dr. Kailes told WJCT if insurers and providers could not agree on what a reasonable, out-of-network charge should be, they could use the FAIR Health database, which includes charge data for billions of billed medical and dental services and procedures, to look for what the usual in the community would be. He contends using the database would help keep the new Florida process fair.
According to the report, he hopes to pitch FAIR Health to regulators once the new law is implemented.
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