The Florida Association of Health Plans' mission is to better the health of Florida's citizens by promoting the growth of health plans dedicated to providing the best service, highest quality of care, best value and affordability, and access to their members and business partners. We do this by:
1. Helping to develop cooperative relationships between health plans, providers, government partners, and employer groups.
2. Advocating for the interests of health plans and their members on legislative and regulatory issues.
3. Educating our members, policy makers, and the public about our health plans and the benefits they provide.
FAHP Statement Regarding Workshop on Balance Billing in Florida House Insurance & Banking Subcommittee (release November 18, 2015)
Tallahassee, Fla. – The Florida Association of Health Plans, Inc. (FAHP) today released the following statement, attributable to President and CEO Audrey Brown, regarding the workshop on unexpected out-of-network medical expenses held in the Florida House Insurance & Banking Subcommittee.
“On behalf of our members, FAHP thanks the members of the Florida House Insurance & Banking Subcommittee for their thoughtful dialogue on unexpected out-of-network medical expenses, or as it is commonly known, balance billing, in today’s meeting.
“Florida’s health plans believe that Florida families are getting hit with surprise medical bills, especially following an emergency, far too often; and, in order to protect consumers, it is necessary to take steps to change the system of balance billing.
“To that end, we support Representative Carlos Trujillo’s good bill, House Bill 221, that puts in place a system that prohibits the practice of balance billing for PPO policyholders and institutes commonsense policies, wherein an out-of-network provider would be reimbursed at the greater of a negotiated rate, the usual and customary rate for the service in the community, or the Medicare rate.
“This workshop is a critical first step in addressing this issue, and we thank Florida’s Chief Financial Officer Jeff Atwater and Consumer Advocate Sha’Ron James for their insight, as well as their continued commitment and focus on this important issue that negatively impacts so many Florida families.
“We look forward to continuing this critical conversation with lawmakers, the CFO and consumer advocate on how to better protect Florida’s families from balance billing practices during the 2016 Legislative Session.”
Audrey Brown: Support bill to end unfair balance billing
October 26, 2015
Far too often medical bills overwhelm families when they’re hit with surprise bills as a result of unexpected emergencies, even families that have purchased health insurance.
The practice of balance billing for emergency services has been detrimental to many, but relief could be on the way thanks to state Rep. Carlos Trujillo. The Miami Republican has filed House Bill 221, which would effectively end the practice of balance billing PPO policyholders who receive emergency medical care from out-of-network health care providers.
Specifically, the proposal would prohibit hospital emergency departments and providers from billing a consumer the balance difference between the retail charges for emergency health care and what the provider receives in payment from the consumer’s copayment or co-insurance and reimbursement from the consumer’s insurer.
Some have recently claimed that portions of Representative Trujillo’s legislation are lifted straight from the pages of the Affordable Care Act (ACA), also known as “Obamacare.” That’s a misrepresentation. The ACA does not prohibit PPO balance billing of consumers or prohibit any form of balance billing for out-of-network services, which is the purpose of Representative Trujillo’s proposal.
Without passage of Representative Trujillo’s HB 221, Floridians with PPO health insurance policies will continue to be balance billed for out-of-network emergency services. Florida law now prohibits balance billing of out-of-network emergency services for patients with HMO health care policies, and those protections were in place long before the ACA came into existence.
Florida’s Insurance Consumer Advocate recently held a forum focused on surprise balance bills. At that hearing the Consumer Advocate illustrated the real-life effects of PPO balance billing. A Boca Raton woman was diagnosed with a brain tumor and was told that she needed emergency surgery. She went to her in-network hospital for the procedure and was unknowingly treated by an out-of-network neurosurgeon at that hospital, resulting in her receiving a balance bill that totaled $81,890 from the out-of-network neurosurgeon as a surprise bill.
Balance billing is a serious issue that’s not only unfair, but can bankrupt a family.
At the Florida Association of Health Plans, and on behalf of our PPO policyholders, we fully support Representative Trujillo’s bill aimed at ending the practice of PPO balance billing for emergency services.
We urge the Florida Legislature to adopt this consumer-friendly bill.
FAHP Releases Statement on Recently-released HEDIS Scores Following AHCA Presentation to Florida Senate Health Policy Committee
For Immediate Release Tuesday, October 20, 2015
Tallahassee, Fla. – The Florida Association of Health Plans, Inc. (FAHP) today released the following statement on behalf of President and CEO Audrey Brown regarding the Agency for Health Care Administration’s (AHCA) report to the Florida Senate Health Policy Committee on the recently-released Healthcare Effectiveness Data and Information Set (HEDIS) scores.
“Since the Statewide Medicaid Manage Care (SMMC) program’s implementation, we have seen many successes, as evidenced by the recently-released AHCA report, showing that in 2014 Florida’s health plans met or exceeded the national HEDIS averages in 65 percent of the categories. In fact, even in areas where they have not yet met the national average, there have been significant improvements in services, such as prenatal care, diabetes management and breast cancer screenings, since the implementation of the SMMC program.
“Overall, the quality of services continues to improve even as the cost per Floridian receiving health coverage under the SMMC program is lower than under the former fee-for-service program; and, Florida’s health plans look forward to continuing to work with our partners at AHCA, in order to continue to achieve better health care outcomes for Florida’s families.”