Crist to Decide Health Bill Fate : Lloyd Dunkelberger

The bill (SB 1122) was one of the most intensely lobbied measures in the 2009 legislative session that ended early last month.

Doctors, dentists and other health care providers pushed the bill because Blue Cross, the state's largest managed care provider, will not directly reimburse out-of-network physicians when PPO patients use them. Instead, the insurer pays the patient who must reimburse the doctor.

Blue Cross officials said limiting direct payments to PPO doctors provides a powerful incentive for the doctors to remain in the cost-saving networks as well as giving the insurer more leverage in negotiating payment rates to the medical providers.

Blue Cross and other opponents of the bill argue that if that incentive is lost, by allowing outside-the-network doctors to be paid directly, more doctors may leave the PPO system and insurers will potentially face higher reimbursement rates that will have to passed on to the patients.

"This bill is bad for consumers and serves no purpose other than to drive up health costs," said Brad Ashwell of Florida PIRG, a nonprofit citizens advocacy group.

"We believe this legislation would raise costs systemwide by undermining the ability of insurers to negotiate reasonable fees with physicians, causing higher insurance rates and higher out-of-pocket medical bills for Florida patients."

worst-case scenarios overblown

Sen. Don Gaetz, R-Niceville, the sponsor of the bill, said the worst-case scenarios being raised by the opponents are overblown.

Gaetz said Humana, the second-largest health care provider in the state, has been allowing direct payments to doctors for the past five years and testified during the session that the company's market share has increased during that time and it has not driven up costs. Other insurers, such as Cigna, are doing the same "and have reported none of these end of the world results," Gaetz said.

It wasn't a powerful lobbying group, like the Florida Medical Association, that got Gaetz to file the bill. Instead, Gaetz said he was approached by officials with a substance abuse center in his Florida Panhandle district.

They told him about drug-treatment patients who were being reimbursed by insurance companies and the money ended up "on the street buying illegal drugs."
An intense fight between doctors and insurance giant Blue Cross Blue Shield that could impact the way tens of thousands Floridians pay for their health care will now be decided by Gov. Charlie Crist.


On Monday, the Republican governor, who is the son of a doctor and has a sister who is a doctor, received a bill that would change the way insurance companies pay for coverage of patients in medical networks known as PPOs, or preferred provider organizations.

The state's doctors, who made the bill their top priority for the session, want Crist to sign it since it would allow doctors outside the medical networks to be paid directly by insurance companies, like Blue Cross. Blue Cross and business groups strongly oppose the bill and want Crist to veto it, arguing that it would severely undermine the cost-saving PPO networks and could cost patients more in the long run.

Crist, who has two weeks to act on the legislation, signaled Tuesday that he may endorse the bill, saying while he has not made a final decision, "so far I like what I see."

Opponents are more skeptical about how often that happens. Barney Bishop, head of the Associated Industries of Florida lobbying group, said the doctors have "raised anecdotal evidence about the patients refusing to remit the insurer check to them" but "we have not seen any evidence that this occurs."

'BALANCE BILLING'

Bishop said Florida businesses are concerned that the bill lacks any protection for patients from a practice known as "balance billing." It occurs when patients leave their PPO networks and end up being liable for the difference between what the insurer will pay the out-of-network doctor and the total bill.

Bishop noted the federal Medicare program for seniors contains a prohibition against balance billing.

"Why wouldn't we extend that protection to all Floridians?" he asked in a letter to Crist this week.

Gaetz said balance billing occurs under the existing law and that patients understand that when they seek care outside their medical networks they can face additional costs. None of that would change under the new bill, he said.

"All this bill does is change the address on the payment envelope," Gaetz said. "It doesn't change the amount that gets paid."

Some lawmakers and a major state workers' union have objected to the bill, warning it could increase costs for the state's managed care plan by up to $18.5 million by 2010.

The state health insurance program is already facing a future deficit of more than $400 million and Doug Martin, a lobbyist for the American Federation of State, County and Municipal Employees, said his union opposes the bill because "we don't want anything to further destabilize" the insurance program.

Gaetz provided a provision in the bill that calls for a review of the law by March 2012 by legislative analysts. If the review shows the state health care network has lost doctors or has seen an increase in costs, the law will be repealed, he said.

Meanwhile, the bill's immediate fate rests with Crist.

And his ties to the medical community may provide a clue on how he will act. For instance, on Tuesday night, Crist was scheduled to attend a fund-raiser for his U.S. Senate campaign in Clearwater where he was to be joined his state finance chairman, A.K. Desai, a doctor who also heads the Universal Health Care company.

Crist also acknowledged that he has talked about the bill with his father, Dr. Charles Crist, and his sister, Dr. Elizabeth Crist Hyden.

He declined to say what they told him. But he added: "You can imagine."

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