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Balance Billing Changes

By Cameron Kruger Pariseau | Categories: Health Law | July 2016

Starting July 1, out-of-network providers in Florida are no longer permitted to bill patients for amounts not paid by the patient’s plan, a practice known as “balance billing.”  Previously, balance billing was prohibited only for patients of HMO plans, but the new bill extends the prohibition to PPOs and EPOs.

The new law impacts out-of-network providers who provide services to a patient at a healthcare facility that is in the patient’s health plan network.  In such cases, the provider can now only bill the patient for their in-network cost-sharing expenses (i.e. copays, coinsurance and deductibles).   Providers who will likely be impacted most by the new law are anesthesiologists and radiologists who contract with surgeons and hospitals to provide ancillary services but remain out-of-network.  The change will likely increase pressure on these ancillary service providers to go in-network.

There are some situations where balance billing is still permitted in Florida, however.  For instance, out-of-network providers may balance bill a patient for services not covered by the patient’s insurance plan.  Additionally, out-of-network providers may balance bill a patient for non-emergency services provided at an out-of-network facility.

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