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Crist Gets Health Benefits Bill

The 15 day clock has started ticking on what is perhaps the most controversial health care bill of the 2009 session.

The measure (SB 1122) requiring insurance companies to pay physicians, hospitals and other providers that are outside their PPO network directly if the insured person makes the request in writing was sent to Gov Charlie Crist on Monday afternoon. Crist will have until June 23 at midnight to sign the bill into law, veto it, or allow it to become law without his signature.

Crist received the bill the same day Associated Industries of Florida President and Chief Executive Officer Barney Bishop sent a letter requesting a veto. Bishop said it would increase health care costs in the new Cover Florida program as well as for employers and employees across the state.

In asking for a veto Bishop’s pro-business association is joining efforts with some groups AIF traditionally has been at odds with, such as the Consumer Federation of the Southeast, Florida PIRG and Florida CHAIN, all of which have asked the governor to veto the bill.

“Over the years, AIF has not agreed with (these groups),” Bishop wrote in his letter. “Yet on SB 1122 we are all in agreement. This bill will increase costs for all Floridians,” he wrote.

Throughout the legislative session opponents argued that the bill would increase costs of care, especially for state employees, many of whom are insured through a self-funded plan administered by Blue Cross and Blue Shield of Florida.

Now opponents say the bill can increase costs for Cover Florida, the health plan Crist helped to create last year to help lower the number of uninsured residents by providing low costs mandate free health care plans

Blue Cross and Blue Shield of Florida is one of two companies to sell Cover Florida plans statewide. Blue Cross and Blue Shield of Florida spokesperson Lauralee Shapiro said the insurer had sold 2,223 Cover Florida plans as of June 4.

The bill seeks to allow insurers to pay out-of-network providers directly, rather than sending a check to the insured person to have them pay the provider.

There was a fierce battle in the Legislature over the bill, which was the top priority for the Florida Medical Association.

It also has been supported by mental health and substance abuse providers who say that when a payment goes to the patient it can end up being spent on drugs or alcohol instead of being sent to providers for the care they rendered.

One such provider is Christopher Crosby, the chief executive officer of Watershed addiction center in Palm Beach County.

Crosby maintains that the bill won’t increase health care costs the way Bishop and other opponents maintain. Current law allows providers to balance bill PPO patients who go out of network. That is, they're allowed to charge patients more than the price the insurance company will reimburse. The bill doesn't change that.

The whole idea of joining a PPO and not an HMO, Crosby said, is to have the additional flexibility to see the provider they want.

Why, Crosby asked, would an insurance company offer PPO plans that allow out of network access but try to discourage them from taking advantage of it?

It “is really upside down,” Crosby said. “It sounds like somebody is trying to sell air to me. It sounds like fraud.”

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