In 2016, when Florida legislators enacted vanguard price-transparency laws, consumers saw a turning point in billing transaction protections.
Initiated to address the increasingly high cost of hospital expense passed on to patients and their families, Florida bill HB 221 established one of the country’s most robust healthcare quality and price transparency systems in the interest of consumer protections against risks such as unexpected out-of-network medical bills.
The legislation also effectively preempted a U.S. federal Supreme Court ruling barring state mandated cost data reporting and sharing with all-payer claims databases for self-insured employers (Gobeille v. Liberty Mutual Insurance Co., No. 14–181 (2016)).
A Brief History of Third-party Billing Reform
Actionable priority within recent reform of Florida’s patient billing systems has been hospital and surgery center data reporting to the state’s Agency for Healthcare Administration (“AHCA”) website.
The web-based, consumer-friendly platform allows consumers access to research on healthcare service price comparisons of specific hospitals and surgery centers, as well as advance disclosure of any “hidden” fees assigned to those provider’s services.
The website also offers consumers up-to-date access to pricing schemes for service bundles according to regional and national location.
Florida law effectuated mandatory pricing disclosure by healthcare providers and insurers as part of the state’s protocol for AHCA network record.
In the interest of greater transparency in insurer pricing, the law requires that healthcare consumers have access to cost-sharing tools.
Clients can now estimate in-network and out-of-network provider fee-for-service costs according to service requests. One of 44 states to receive an “F” grade in a national payment reform effort targeting healthcare cost transparency in 2015, Florida has since amended the bill signed into legislation a year later.
The Latest Healthcare Pricing Reforms
Effective February 19. 2018, Florida law 59A-3.256 Price Transparency and Patient Billing affirmed the final amendment to 2017 Florida statute Title XXIX Public Health, Chapter 395.301 Price Transparency; itemized patient statement or bill; patient admission status notification AHCA protocols for disclosure of fee-for-service pricing of healthcare services.
The reform mandates “availability of estimates of costs that may be incurred by the patient, financial assistance, billing practices, and a hyperlink to the Agency’s service bundle pricing website” (1).
Statutory provision for the descriptive service bundles was developed under 2017 Florida Center for Health Information and Transparency legislation 408.05(3)(c).
Florida’s robust, cost-transparent healthcare reporting database holds hospitals, surgery centers, insurers, and third-party administrators operating in the state accountable for accuracy in reporting.
The legislation also covers Medicaid and state employee health benefits program reporting. Participation in those programs in Florida requires claims data disclosure by all medical providers serving consumers in the state.
Opting out of claims data reporting to the AHCA is a decision to cease operating in Florida.
Contact an Insurance Law Attorney
In Florida, patients have a right to full disclosure of healthcare service costs.
If you have recently been subject to questionable billing practices by a healthcare service provider operating in Florida, it may be time to consult with an attorney.
A licensed attorney specializing in insurance law can represent you in filing a claim for recovery of healthcare related compensation in court.
Florida Department of State, Florida Administrative Code and Administrative Register, 59A-3.256 Price Transparency and Patient Billing, https://www.flrules.org/gateway/ruleNo.asp?id=59A-3.256
Florida Legislature, The 2017 Florida Statutes, Title XXIX Public Health, Chapter 408.5, Florida Center for Health Information and Transparency, Online Sunshine, http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0408/Sections/04
Florida Legislature, The 2017 Florida Statutes, Title XXIX Public Health, 395.301 Price transparency; itemized patient statement or bill; patient admission status notification, http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0300-0399/0395/Sections/0395.301.html
United States Supreme Court, Gobeille v. Liberty Mutual Insurance Company, No. 14-181 (2016), ScotusBlog, http://www.scotusblog.com/case-files/cases/gobeille-v-liberty-mutual-insurance-company/