Medical Consumer Protection

Scenario: An unexpected illness befalls you which forces you to seek emergency care at a local hospital, and the emergency medical providers recognize that it is a serious matter before admitting you for treatment, which lasts several days. As you struggle to improve your health, you are uneasy because you are not sure what your private health insurance will cover. Or, like many Florida residents, you may not have any health insurance and fear future bills from your hospital stay placing you into a financial crisis.

The above stressful scenario, while common, is much easier to manage if patients understand their options to lower their medical bills upon discharge from a Florida hospital or clinic.

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What are the billing options for Florida patients?

In 2016, the Florida Legislature enacted the Balance Billing Protection (No Surprises Act), one that prevents medical providers from charging patients for any balance not paid by the patient’s insurer. The Act also protects patients by ensuring “no surprises” in billing, including any unexpected balances. 

Under the No Surprises Act, Florida patients are further protected from balance billing for:

  • Emergency services

If you receive emergency services in Florida at a facility that is outside of your insurance company’s network, you can only be billed for your plan’s cost-sharing amounts (co-payments, deductibles, etc.).

  • Certain services at hospitals or surgical centers

For any services you receive during a hospital or surgical center stay that are provided by out-of-network professionals, you can only be billed for your insurance plan’s cost-sharing amount. Unless you have given express written consent to the contrary.

It is important to note that if you are a Florida resident enrolled in a Florida Health Management Organization (HMO), then you are also afforded the same “no surprise” protections for out-of-network treatment provisions. 

What are payment options for Florida patients?

If you are insured or a member of an HMO, but the co-pay, deductible, or non-covered costs are still too steep, or you are uninsured and facing a five or six-figure bill for medical services, what can you do to mitigate costs?

First, it is important to know that the major credit reporting agencies do not report nonpayment of medical bills for six months from the date of invoice, which means that you certainly have time to take the following steps:

  1. Check the bill for errors: Medical providers’ billing departments can (and do) make mistakes, so it is important that you carefully view each line item to ensure that the services listed were actually provided during your treatment.
  1. Contact the billing department to negotiate a lower bill: Medical providers are aware that patients often cannot afford the total costs of treatment, which is why many are often willing to negotiate a settlement. Be sure to contact the billing department immediately as time is of the essence with regards to credit agencies reporting non-payments 180-days after invoice.
  1. Are you eligible for coverage under Medicaid? Medicaid was signed into law by President Lyndon B. Johnson in 1965 to provide medical insurance coverage for lower-income Americans, with the individual states being responsible for disbursing funds for eligible residents. In Florida, the minimum eligibility is $17,000 per year for a single person, and $35,000 per year for a family of four, which is determined by providing Florida’s Department of Children and Families with copies of your recent tax return(s). If eligible, a new Medicaid enrollee could be granted “retroactive billing,” which means that costs for medical services that were accrued 90 days before enrollment could be eligible for coverage.
  1. Ask the medical providers billing department whether they participate in any patient advocacy groups that help defray costs of services. If yes, the billing department will provide you with contact information for charitable groups and non-governmental organizations (NGO) that assist patients in need of financial assistance for costs.
  1. Ask the medical providers for a payment plan: Hospitals, surgical clinics, and walk-in clinics provide valuable health care services, but they are all businesses that maintain an active interest in being paid for their services. Whether you can afford to pay the bill as is or negotiate a lower bill, you should still ask whether the provider would be willing to establish a payment plan that fits your budgetary needs.

Contact Fasig | BrooksIf you have any questions about your rights as a medical consumer in Florida, feel free to contact the lawyers of Fasig | Brooks at our offices in Tallahassee, Destin, or Jacksonville, today.