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“Certain payments directly to doctors under new Florida health law”
June 10, 2009
“Crist signs Fla. Health insurance bill”
June 10, 2009
“Gov. Crist signs health insurance bill”
June 10, 2009
“Controversial bill signed by Crist”
June 10, 2009
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What is an “Assignment of Benefits” (AOB)?
An assignment of benefits (AOB) occurs when an insured patient authorizes a payment from an insurer to be made directly to his or her doctor for medical care, regardless of whether the doctor is a participating provider in the insurer’s network.
Under SB 1122, patients would have a choice about whether to have insurance payments sent directly to their doctor. If patients wish for payments to be sent directly, insurers would have to honor this request.
What problem does SB 1122 solve?
Insurers have been engaging in unfair business practices by not honoring a patient’s valid AOB to a doctor. SB 1122 will ensure that, when patients request it, doctors receive reimbursement directly from insurers, rather than funds being sent to patients first.
When insurers send funds to patients instead of directly to doctors, it creates a great hassle for patients and creates burdens on doctors’ offices. Patients must often pay out-of-pocket for care and then wait for insurers to reimburse them. Further, too often, patients do not forward funds to the doctor after receiving it.
SB 1122 will allow doctors and their staff to spend less time on paperwork and more time on patient care.
SB 1122 will reduce administrative hassles and will go a long way toward correcting the imbalance of power that exists between doctors and insurers.
Who will SB 1122 benefit?
Patients: SB 1122 will reduce hassles for patients, including paying out-of-pocket for care and waiting for the PPO to send reimbursement through the mail.
Patients: SB 1122 will reduce paperwork and administrative burden in doctors’ offices, which means more time for patient care.
Patients: SB 1122 will reduce the overhead costs for doctors’ offices, including staff time and collections processes, thus helping to lower the cost of healthcare in the big picture.
Special needs and vulnerable patients: A strong portion of claims that are filed for out-of-network care are for mental health, substances abuse, and behavioral health services. Those needing these services are the most vulnerable among us and often cannot access care otherwise. SB 1122 will expand access to care for these patients.
What will be the fiscal impact to the State of Florida?
None.
Data from other states, including Florida, demonstrate that AOB laws do not increase the cost of State Employee Health Plans, and do not cause an increase in premiums.
Colorado passed AOB laws in 2005 and has experienced no fiscal impacts whatsoever: there was no loss of providers in the state plan network, and no cost to state employees.
Ohio actually predicted a savings to local governments through the passage of AOB laws due to direct payment to municipal providers.
Many states have considered or passed AOB laws without reporting any fiscal impact in their analyses, including: Connecticut, Idaho, Louisiana, Maine, Maryland, Ohio, Alabama, Alaska, Georgia, Missouri, Nevada, New Hampshire, Tennessee, Texas, Washington and Wyoming.
What will be the fiscal impact to consumers and policyholders?
SB 1122 empowers consumers. It gives patients greater choice in how insurance payments are provided.
No state with AOB laws has experienced an impact on consumers. If anything, consumers will save money by reducing office burdens that could add unnecessary costs to the doctors’ fee.
Humana in Florida began honoring AOB in 2005. Humana reports that this policy has had no impact on premiums or cost to consumers.
Will SB 1122 cause doctors to stop participating in provider networks?
Data in other states, including Florida, proves that doctors do not leave provider networks due to mandatory AOB laws.
AOB laws have been in effect on some other states for decades, with absolutely no deterioration of insurer provider networks.
Humana in Florida did not experience any drop in provider participation after they began honoring AOB in 2005. In fact, network participation has increased since that time.
Doctors have many reasons to stay in an insurer’s network. AOB laws will not change that whatsoever.
Does SB 1122 permit doctors to charge patients more?
No. SB 1122 does not change the way that out-of-network doctors charge patients.
If anything, SB 1122 will lower costs to consumers, as doctors will have fewer administrative costs and burdens in the reimbursement process.
Why is the Blue Cross argument off-base?
The Blue Cross argument is based fully on the assumption that without direct payment, doctors will have no incentive to remain in the insurer’s network.
This assumption is false.
This assumption is also debunked by data collected in other states as well as in Florida.
When actual data is available, it is irresponsible and manipulative to base Fiscal Impact Statements on arbitrary “assumptions.”
Actual data is available for addressing this policy question; however Blue Cross has ignored facts in order to perpetuate their company’s profit motives.
