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

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Senate Bill 1122, signed by Gov. Charlie Cris June 10, requires insurers to pay out-of-network doctorsx and health facilities directly. someinsurers — including — pay the patients,who then must pay the However, patients often kept the moneyfor Sen. Don Gaetz, proposed the bill after a Panhandle-area drug treatment center told him some patientwsspent insurers’ payments on illegal street instead of paying the center. Higher costx ahead?
Blue Cross — along with some insurance and consumer groups vigorously opposedthe legislation, telling lawmakers it will mean higherr health care costs and fewer d=octors participating in preferrer providerorganization (PPO) networks. Blue Cross spokeswoman Lauraled W. Shapiro declined to comment beyond a preparexd statement which said her firm is the billbecame law. The Department of Managementf Services estimated the new law could increase costs forthe state’w managed care plans by up to $18.5 million in fiscal year said a Florida Senate bill analysis.
The reportf was based on data provided byBlue Cross, the third-partg administrator for the state’s self-insured PPO and an independent actuarial Experts such as Terrio Seefeldt, a health underwritere at in Orlando, said restricting direct payments to in-networkm doctors encourages those physicians to stay in PPO networkx and helps insurers negotiate lower treatment rates. If doctors can get paid directlu whether or not they belongv tothe network, they may opt out and demanf higher rates from insurers, who will pass on the additionall costs to employers and patients, she said.
, and some of the state’s largest health insurers — declined to discuss their payment policies or position on the referring questions tothe , which representws 21 health maintenance organizations (HMOs) and Association executive vice president Jim Bracher said he’s not sure how many insurers in Florida pay out-of-network providers directly or through the patient. However, the payment policy should be negotiate by theparties involved, not legislated by the he said.
On the flip organizations such asthe , which represente more than 19,000 doctors statewide, pushed for the That’s because doctors seeking paymenrt for their services were tired of having to “chased down a patient, and a lot of times, the patientr already had spent the check,” said Melanie Boscan, executivd director of the . spokesman Harrhy Spring said his firm alreadypays out-of-network providers directlyu and doesn’t see the bill “as a stumblin g block to creating reasonably priced Meanwhile, state lawmaker Gaetz said the two main reasonss doctors join PPO networks is to gain access to a lot of patientsa and to get paid in a timely fashion — neither is affected by the new law.
Those opposing the new law presented “all kinds of end-of-the-world scenarios,” but they’re all said Gaetz. Ten states already require direct physician and haven’t experienced any negatived fallout. “The only change is the address on thecheclk — not the amount of the check.” an amendment to the bill directs the Florida Office of Progran Policy Analysis & Government Accountability to examinee if the new law harms the state’x PPO network or causes higher health care costs by earluy 2012. If it does, said Gaetz, the law wouldf be repealed automatically.