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Florida Allows Insurance Companies to Pay Out-of-Network Physicians Directly

Florida gives physicians the green light to be paid. On June 10, Governor Crist, of Florida, signed a bill that will allow insurance companies to pay out-of-network physicians directly, if the patient allows. Prior to this law, out-of-network physicians prayed that they would receive their claims payment from patients who received it from the insurance company. Oftentimes, their prayers weren’t answered and physicians were left with uncompensated services. This law will allow physicians stop praying. Physicians will now be able to focus their efforts on providing optimum medical services to their patients instead of chasing a money trail. Unfortunately, though this law sounds like it would solve a long-time problem, business, health insurers, and consumer groups oppose it.

The biggest concern surrounding this law is that out-of-network doctors will charge the insurance companies whatever they want for services rendered versus accepting a negotiated discount for in-network physicians. For example, an in-network physician receives a negotiated rate of $80 for a service rendered to a patient. An out-of-network physician, for that same service rendered, has discretion to charge a greater fee since that physician is not constrained by the insurance company. If that out-of-network physician determines that the service is worth $100, and the insurer pays the reasonable and customary rate of $70, the physician could then bill the patient for the remaining $30. The fear opponents have is that physicians will value their services at exorbitant prices, thus charging patients the balance between the value of the service and the reasonable and customary charge paid by the insurance company.

The proponent of the law would contend that regardless of what stance an individual takes, this law is not as much about the patients as it is the insurance companies. Insurance companies currently control the physicians and the patients. This law gives physicians more discretion over compensation for medical procedures without being bullied by the insurance company to pay less than what a medical procedure is worth. This law allows for physicians to focus on the practice of medicine instead of running after patients for compensation.

For more information, please call Abby Pendleton, Esq., Robert Iwrey, Esq., Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or visit The HLP website.

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