Transparency Law

The Florida Senate - 2016 Summary of Legislation Passed - Committee on Health Policy
CS/CS/HB 1175 – Transparency in Health Care

By Health and Human Services Committee; Health Care Appropriations Subcommittee; Rep/ Sprowls and others (CS/SB 1496 by Appropriations Committee; and Senators Bradley and Gaetz)

The bill increases the transparence and availability of health care pricing and quality of service information to enable consumers to make informed choices regarding health care treatment. The Agency for Health Care Administration (AHCA) is required to contract with a vendor to provide a consumer-friendly, Internet based platform that allows a consumer to research the cost of health care services and procedures. The AHCA is to select the vendor through a competitive procurement process.

Services and procedures will be grouped by a descriptive service bundle to facilitate price comparisons provided in hospitals and Ambulatory Surgery Centers (ASC). Quality indicators for services at the facilities will also be made available to the consumer to assist with health care decision-making.

Hospitals and ASCs are required to provide access to the searchable service bundles on their website. Consumers will be presented with the estimated average payment received, excluding Medicaid and Medicare, and estimated payment ranges for each service bundle, by facility, facilities within geographic boundaries and nationally. The facility must disclose that this information is an estimate of costs and the actual costs will be based on services actually provided to the patient. Additionally, the facility must disclose the facility’s financial assistance policies and collection procedures.

The hospital and ASC must notify prospective patients that other health care providers may provide services in the facility and bill separately from the facility. Furthermore, the prospective patient must be informed that these healthcare providers may or may not participate with the same health insurers or Health Maintenance Organizations (HMOs) as the facility. Accordingly the patient should contact the applicable practitioners to determinate the HMOs with which the practitioner participates as a network or preferred provider. The facility must provide contact information for the practitioners.

Insurers and HMOs are required to provide on their websites a method for policy holders to estimate their cost sharing responsibilities by services bundled based on the insured’s policy and known plan usage. These estimates shall include both in-network and out-of-network providers. Insurers and HMOs are also required to provide hyperlinks on their website to the AHCA’s performance outcome and financial data.

Consumers may request personalized good faith estimates of charges for nonemergency medical services from hospitals, ASCs and health care practitioners relating to medical services provided in the hospital or ASC. These good faith estimates must be provided to the consumer within 7 days after the consumer’s request. The bill provides for a daily fine for non-compliance by facilities and health care practitioners. The personalized estimate must also inform the patient about the health care providers financial assistance policies and collection procedures.

A patient may also request an itemized bill or statement from the hospital and ASC after discharge. The requested itemized bill or statement must be provided within 7 days and be specific, written in plain language, and identify all services provided by the facility and any facility fees, as well as rates charged, amounts due, and payment status. The itemized bill or statement must inform the patient to contact his or her insurer regarding the patient’s share of costs. The facility must provide records to verify the bill or statement within 10 days after a request and respond to the questions concerning the statement or bill.

The bill requires health insurers and HMOs that participate in the state group health insurance plan or Medicaid managed care to submit all claims data from Florida policy holders, with certain supplemental plan exceptions, to the vendor selected by AHCA.

Each diagnostic imaging center operated by a hospital but not located on the hospital grounds is required to post in the reception area prices charged to uninsured persons for the 50 most frequently provided services. The bill prohibits the AHCA form establishing an all-payor claims database or a comparable database without express legislative authority.

If approved by the Governor, these provisions take effect July 1, 2019.
Vote: Senate 34-1; House 116-1

Financial Arrangements

Making Arrangements

The facility will contact you prior to your procedure if payment is due at the time of service. In most cases, we should be able to estimate the cost of surgery beforehand. Our staff will also help you finalize your financial/payment arrangements prior to your procedure.

Charges

Billing for the facility and physician(s) are separate. The surgery center charges include use of the operating room, equipment and supplies for your procedure. You will be billed separately for the services of your physician, anesthesiologist, and pathology services (if applicable).

Payments

Uninsured and cash patients will be required to pay or make arrangements for payment prior to the delivery of care. For patients with insurance, your plan benefits will be verified and you will then be notified of your financial responsibility per the information provided by your carrier. As a courtesy to our patients, we accept Visa, MasterCard, American Express, Discover Card, debit cards and Care Credit.

CareCredit® is a credit card issued exclusively for use in paying for your health care expenses. You can apply for a CareCredit® card to cover the facility portion of your bill at our facility or by calling them directly at: (800) 677-0718 or from their website www.carecredit.com.
*Subject to credit approval. Minimum monthly payments required. See provider for details.

The benefit information provided prior to the delivery of care is considered to be only an estimate. Once your insurance company has been billed for services, there may be an additional balance due which is your responsibility. You will be billed for any additional fees that may be listed a patient responsibility by your insurance carrier and prompt payment is expected. The facility reserves the right to accept or decline patients on an individual basis in regards to financial agreements.

Information on Payments

Our facility offers a variety of ways to modify a patient’s financial responsibility for services rendered by the surgery center. Certain service providers (such as Anesthesiologists or laboratories) bill for their services separately from the surgery center and may offer their own financial assistance program—please contact them for further information regarding their services.

Payment Plans

Each patient is expected to pay his/her estimated financial liability on the date of service. In the event a patient is unable to pay the estimated liability in full, our surgery center may, but is not obligated to, offer a short term repayment schedule after a minimum down payment is made. For an extended repayment schedule, a patient will need to secure financing with an outside source. Please contact us for further information.

Un-insured / Self Pay

Patients who are un-insured/self-pay may be eligible to receive an uninsured discount from our facility. The discounted amount is a set flat rate off of total charges and is subject to change. If a un-insured payment arrangement is made and patient’s account is subsequently found to be delinquent, the uninsured discount may be disallowed.

Out of Network

A patient receiving treatment at our surgery center under insurance with which our facility is out of network may be eligible to receive an adjustment to their assigned out of network patient liability, assuming our facility is not prohibited from offering Out of Network adjustments under state/Federal laws or your insurance company’s provisions. If not prohibited, the application of any out of network discount is subject to vary based on a patient’s benefit coverage. Accounts which become delinquent may have the adjustment disallowed.

Collection Procedures

As a courtesy to our patients, we will file an insurance claim on behalf of the patient to his/her insurance plan. A patient is expected to respond to his/her insurance plan’s request for information timely, as needed, in order to minimize claims processing delays.

Patients are expected to comply with their financial obligations in a timely manner including paying the estimated portion by the day services are received, and any remaining portion upon finalization of the claim by the payer. Further, patients are expected to remit any payments made directly to them (as opposed to the facility directly) from out of network insurers.

The facility will attempt to reach a patient by any method available to us to secure payment on any outstanding balance utilizing internal and external resources. If the account becomes delinquent, it may be placed with a collections agency or attorney for collection. In that case, the patient may also become liable for all costs and fees expended on collection attempts.

Other Providers

Services may be provided in this health care facility by the facility as well as by other health care providers who may separately bill the patient and who may or may not participate with the same health insurers or health maintenance organizations as the facility.

Patients and prospective patients may request from this facility and other health care providers a more personalized estimate of charges and other information. Patients and prospective patients should contact each health care practitioner who will provide services in this surgery center to determine the health insurers and health maintenance organizations with which the health care practitioner participates as a network provider or preferred provider.

Contracted Service Providers

The following providers render services to patients of this surgery center and will bill patients separately. Patients should contact:

Pathology

EndoChoice Inc.
11405 Old Roswell Rd
Alpharetta, GA 30009
Phone: 888-682-3636

Mid-Florida Pathology

120 East North Blvd., Suite 102
Leesburg, FL 34748
Phone: 352-460-0292

Lake Gastroenterology Associates – Pathology

1858 Mayo Drive
Tavares, FL 32778
Phone: 352-383-5200

Pathology Laboratories

822 Perkins Street
Leesburg, FL 34748
Phone: 352-315-4111

Keller & Goodman, M.D., P.A.

1879 Nightingale Lane, Suite C-2
Tavares, FL 32778
Phone: 352-742-7776

Anesthesia

Rest Assured Anesthesia LLC
1878 Mayo Drive
Tavares, FL 32778
352-508-5812

All other inquiries about physician billing should be addressed to your physician’s office.

Useful Links

Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for general information: www.ahca.myflorida.com
Patients may access the State of Florida’s Agency for Healthcare Administration website at this link for information about our surgery center: www.floridahealthfinder.gov
Patients may access the All-Claims Payor Database (ACPD) as follows: www.apcdcouncil.org/state/florida
  
 
Friday December 14, 2018