WEST PALM BEACH, Fla. — Call it the hassle factor.
You visit an out-of-network doctor, your insurance company reimburses you instead of the doctor, and you have to manage the paperwork.
Health insurance companies inflict this annoyance intentionally, saying it amounts to an offer that doctors cannot afford to refuse: Join the network, or suffer the consequences.
A bill that passed both houses of the Florida Legislature this session, referred to as the direct-pay bill, would require preferred provider organizations, or PPOs, to pay out-of-network doctors directly if a patient makes that request when signing forms.
No more hassles.
Simple as it sounds, though, as it awaits Gov. Charlie Crist's signature, Senate Bill 1122 has engendered a knock-down, drag-out, big-money fight between doctors and insurance companies.
Doctors tired of waiting to get paid want the bill signed now. Large reimbursement checks, when sent to patients, have a way of disappearing.
While eliminating paperwork hassles might seem great for patients, too, consumer groups are siding with insurance companies asking for a veto. They're offering dire predictions about the unraveling of managed care if it's allowed to become law.
Blue Cross, Florida PIRG (formerly known as the Florida Public Interest Research Group) and the Consumer Federation of the Southeast warn that direct pay would undercut insurance companies' ability to negotiate with doctors. The number of doctors participating in networks could plummet, they warn.
"We believe this legislation would raise costs systemwide by undermining the ability of insurers to negotiate reasonable fees with physicians," said Brad Ashwell of Florida PIRG, in a statement.
The result could be higher insurance rates and higher out-of-pocket costs, he warned.
The consumer federation warned that wiping out the hassle factor would leave patients stuck paying higher bills.
If doctors can get paid easily out of network, they need not join.
"This will open the door for doctors to 'balance-bill,' or charge patients an additional amount over what their insurer will pay," warned the consumer federation, which hired top public relations firm Ron Sachs Communication to get out its message.
In You Tube videos and television ads, meanwhile, the Florida Medical Association is accusing the insurance companies of scare-mongering.But at least one staff analysis of the bill's impact did predict some scary results.
According to the General Government Appropriations committee report, the Department of Management Services estimated, based on information provided by BlueCross and BlueShield of Florida, the third-party administrator for the state's self insured Preferred Provider Organization, that the bill could add $5.1 million to $18.5 million in costs to the State Employees' Group Health Insurance Program next year. Out-of-pocket costs for patients "could potentially increase by 75 percent," the report said.
Still, it passed, and awaits action from Crist.
Stacey Singer writes for The Palm Beach Post. E-mail: stacey(underscore)singer(at)pbpost.com.