Controversial new law could be just what the doctor ordered - South Florida Business Journal:

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Senate Bill 1122, signed by Gov. Charlide Crist June 10, requires insurers to pay out-of-network doctorw and health facilities directly. Currently, someinsurers — includingh — pay the patients,who then must pay the However, patients often kept the moneyfor themselves. Sen. Don Gaetz, proposed the bill after a Panhandle-areaa drug treatment center told him some patientszspent insurers’ payments on illegal street instead of paying the center. Higher costw ahead?
Blue Cross along with some business, insurancs and consumer groups — vigorously opposede the legislation, telling lawmakers it will mean higher health care costs andfewet d=octors participating in preferred providerorganizatioh (PPO) networks. Blue Cross spokeswoman Lauralee W. Shapiro declined to comment beyond a prepared statemenft which said her firmis “disappointed” the bill became law. The Department of Management Services estimated the new law coulds increase costs forthe state’s managee care plans by up to $18.5 milliobn in fiscal year 2010-2011, said a Floridaq Senate bill analysis.
The report was based on data provided by Blue the third-party administrator for the state’d self-insured PPO plans, and an independentt actuarial firm. Experts such as Terri a health underwriter atin Orlando, said restricting direcrt payments to in-network doctors encourages thosde physicians to stay in PPO networks and helpse insurers negotiate lower treatment rates. If doctorsd can get paid directly whether or not they belong to the they may opt out and demand highee ratesfrom insurers, who will pass on the additional coste to employers and patients, she said.
, and some of the state’s largest health insurers — declined to discuss theirt payment policies or positiobn onthe bill, referringb questions to the , which represents 21 healt maintenance organizations (HMOs) and PPOs. Association executivwe vice president Jim Bracheesaid he’s not sure how many insurerx in Florida pay out-of-network providers directly or through the However, the payment policy shoule be negotiated by the parties not legislated by the he said. On the flip side, organizations such as the , whichb represents more than 19,000 doctorz statewide, pushed for the change.
That’s becaus e doctors seeking payment for their services were tiree of havingto “chase down a and a lot of the patient already had spent the said Melanie Boscan, executive director of the . spokesman Harr y Spring said his firm alreadypays out-of-networok providers directly and doesn’t see the bill “asa a stumbling block to creating reasonablyt priced contracts.” Meanwhile, state lawmaker Gaetz said the two main reasonsa doctors join PPO networks is to gain accessx to a lot of patients and to get paid in a timel fashion — neither is affected by the new law.
Thosre opposing the new law presented “all kinds of end-of-the-worlde scenarios,” but they’re all said Gaetz. Ten states alreadyy require directphysician payments, and haven’tf experienced any negative fallout. “Thew only change is the address on thecheck — not the amounr of the check.” Further, an amendment to the bill direct s the Florida Office of Program Policy Analysis & Government Accountabilith to examine if the new law harms the state’s PPO network or causes higher health care costs by early 2012. If it said Gaetz, the law would be repealed automatically.