The health care industry is unfortunately plagued with many issues in today’s world. Among these many issues, a few to discuss today include insurance coverage and comprehension. In addition to this, the nationwide shortage of healthcare professionals has a compounding negative impact on the physician patient relationship. Due to this it may seem we are being rushed in and out of the physician’s door without really learning anything new or having our issues addressed carefully enough. Numerous healthcare professionals have mentioned this as one of the top issues they acknowledge and wish they could change. To better prepare yourself for a visit, it is always good to know what your rights are beforehand. And to assist with this, we have compiled a few things to know about insurance coverage as well as some state laws already in place that you might not be aware of.
Florida law requires hospitals and surgery centers to provide a written estimate of what you might be charged for any non-emergency service, within 7 days of your request. The estimate is not a guarantee of your actual costs, and it may not include any discounts negotiated by your insurance company – but it can be a starting point to help you plan. Health insurance companies and health maintenance organizations (HMOs) in Florida are required to provide a cost-calculator on their websites to help members estimate their out-of-pocket costs – based on the member’s individual contract and plan.
Hospitals and surgery centers licensed in Florida are also required by law to provide detailed, understandable billing statements to patients that include the dates, services performed, and specific providers for all care that you received during your stay. The account statement or bill must also show whether each item is paid, pending payment by a third party (insurance or other), or due from the patient. If there is any amount due from the patient – the bill must provide a due date along with information on how to contact a patient liaison in the hospital’s billing office to assist with any questions or disputes. Hospitals are required by law to respond to your billing questions within 7 business days.
Beginning July 1, 2019 – Hospitals licensed in Florida must notify patients who are placed on “Observation Status” rather than admitted as in-patients. It is important to understand from your insurance company how this might impact your billing and coverage for your stay.
Some hospitals and surgery centers sign contracts with separate provider groups to perform certain services in their facilities – common examples include anesthesia, radiology, and emergency department doctors, among others. These provider groups may bill you separately for the services they provide – and you have a right to know who they are.
Hospitals and surgery centers in Florida are required to maintain a list on their websites of any providers who may perform services in their facility and bill patients separately, along with contact information.
Any written estimate of charges you receive from a hospital or surgery center must also include a list of those providers and their contact information – with instructions to contact them for an estimate of their charges and to determine whether they are in your insurance network.
Sometimes you do not get to plan or choose your hospital or provider, such as during an emergency.
If you have health insurance and go to an emergency room, all the providers who care for you during that visit are required to accept the allowed amount from your insurance company as payment in full and are prohibited from billing you anything above that amount – a practice known as balance billing. Florida law also protects patients from balance billing any time you do not get an option to choose an in-network provider. This can be helpful if you are unable to make the decision of where care is provided before you even receive it.
Bill of Rights and Responsibilities
Florida Law establishes the following Patient Rights and Responsibilities:
A patient has the right to:
- Be treated with courtesy and respect, with appreciation of his or her dignity, and with protection of privacy.
- Receive a prompt and reasonable response to questions and requests.
- Know who is providing medical services and who is responsible for his or her care.
- Know what patient support services are available, including if an interpreter is available if the patient does not speak English.
- Know what rules and regulations apply to his or her conduct.
- Be given by the health care provider information such as diagnosis, planned course of treatment, alternatives, risks, and prognosis.
- Refuse any treatment, except as otherwise provided by law.
- Be given full information and necessary counseling on the availability of known financial resources for care.
- Know whether the health care provider or facility accepts the Medicare assignment rate for patients covered by Medicare.
- Receive prior to treatment a reasonable estimate of charges for medical care.
- Receive a copy of an itemized bill and have the charges explained.
- Receive medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment.
- Receive treatment for any emergency medical condition that will deteriorate from failure to provide treatment.
- Know if medical treatment is for purposes of experimental research and has the right to give his or her consent or refusal to participate in such research.
- Express complaints regarding any violation of his or her rights.
A patient is responsible for:
- Giving the health care provider accurate information about present complaints, past illnesses, hospitalizations, medications, and any other information about his or her health.
- Reporting unexpected changes in his or her condition to the health care provider.
- Reporting to the health care provider understanding of a planned course of action and their role.
- Following the treatment plan recommended by the health care provider.
- Keeping appointments and, when unable to do so, notifying the health care provider or facility.
- Their actions if treatment is refused, or if the patient does not follow the health care provider’s instructions.
- Fulfilling financial responsibilities.
- Following health care facility conduct rules and regulations
After it is all said and done, we understand that these topics and situations can be stressful and confusing. We hope to have laid things out in a simple format that brings clarity and understanding to insurance coverage and health care patient rights that will continue to evolve with new procedures and state laws.