Florida Gov Signs Out-of-Network Payment Bill

June 18, 2009
Special Feature

The Governor of Florida recently signed a bill that will require insurance companies to pay out-of-network doctors directly if the patient agrees.

When a patient visits an out-of-network doctor, the payment for the service usually goes to the patient, who is then supposed to pay the doctor. Because the patient often didn’t send the payment to the doctor, out-of-network doctors have chafed under these rules. Now, they have won some relief, at least in the state of Florida. There, Gov. Charlie Crist recently signed a bill that would require insurance companies to pay out-of-network doctors directly if the patient agrees.

The bill met with strong objections from insurance companies, consumer groups, labor unions, and the Associated Industries of Florida, the lobbying group for the state’s large businesses. The critics argue that the law would encourage doctors to remain outside networks where fees are negotiated. With fewer doctors in PPOs, more patients would be forced to see out-of-network doctors and might be subject to costly out-of-pocket fees.

Out-of-network doctors have always had the right to charge whatever fees they set, but they often had to wait for payment until the patient’s insurance company reimbursed the patient, who in turn was supposed to send payment to the doctor. Under the new Florida law, however, any payment from the patient’s insurance company will be sent directly to the doctor, who can then balance bill for anything above that. Direct payment has been a major selling point to entice doctors to join provider networks and critics fear that fewer doctors will opt to join because of the new rules, jeopardizing the efforts to rein in the cost of medical care.