Community Health Action Information Network Surprise Medical Bills Advocacy in Florida February 4, 2016 Laura Brennaman, PhD RN Policy & Research Director, Florida CHAIN 1

Community Health Action Information Network About us.. FL CHAIN – Community Health Action Information Network Statewide, non-partisan consumer health advocacy organization dedicated to improving the health of Floridians by promoting access to affordable, quality health care. Recognized by media, lawmakers (R and D), state and federal officials, and consumer advocacy organizations as a credible source of information. Work to monitor implementation and push for reforms to be as consumer friendly as possible.

Community Health Action Information Network Solutions to the surprise balance bill Insurers and providers must hold patient harmless from out-of- network charges in any case where the consumer has no choice – Patients should be responsible for their in-network share of costs only Resolution of out-of-network charges should exclude consumer participation Surprise out of network providers cost-sharing apply to in-network deductible Provider directories must identify in-network facilities without in- network contracted hospital-based providers Network adequacy of necessary provider types

Community Health Action Information Network Status Quo for Balance Billing in Florida Source: Consumer Reports® National Research Center. Surprise medical bills survey: 2015 nationally-representative online survey

Community Health Action Information Network Charles Baker had chest pain The hospital is in network The ER docs are out of network Balance billed $1,235 The ER physician group practices at hospitals throughout the area ER physicians are OON for major insurers

Community Health Action Information Network Florida CHAIN entered the Discussion Working through the regulatory & executive branch

Community Health Action Information Network Gained Public Exposure at Insurance Consumer Advocate Office

Community Health Action Information Network Invited to the Table to Provide consumer stories Provide links to national consumer focused resources Provide recommendations for legislative language Provide channels of communication between providers & insurers with consumer focus Provide technical guidance regarding dispute resolution proposals

Community Health Action Information Network Reaching out to other Stakeholders

Community Health Action Information Network Leverage National Partnerships

Community Health Action Information Network Highlights of pending legislation Senate Bill 1442House Bill 221 (committee subst) Hospital disclosure Hospitals must notify about OON providers OON providers may not balance bill without notice Hospital must post network affiliations contract provider affiliations & contact information Consumer protection Emergency No “ability or opportunity to choose” Emergency No “ability or opportunity to choose” Dispute resolution The greater of: Usual in-network rate Usual & customary reimbursement Medicare rate Baseball style arbitration following private negotiation Insurer disclosure Not addressed Provider directory monthly update Notice of OON charges at point of purchase

Community Health Action Information Network

Consumer uses in-network facility & surgeon In-network surgeon Completes pre-authorization Confirms in-network hospital Out of network anesthesiologist Out of network pathologist = Large out of network “balance bill” CHOICE When consumers have no choice insurers and providers must hold consumers harmless

Community Health Action Information Network Next steps

Community Health Action Information Network Contact Information Laura Brennaman PhD RN Policy & Research Director, Florida