Prohibited Balance Billing in Florida

Florida medical providers must be extremely careful when balance billing patients. The consequences of making a mistake can be costly.

Section 559.72(9) Florida Statutes prohibits attempting to collect a debt that is not due. The punishment can be the assessment of actual damages, a civil fine, and the payment of the Plaintiff’s attorney’s fees and court costs. Section 559.77 Florida Statutes.

Many statutes, most private health insurance policies, and Medicaid and Medicare prescribe how much, if any, a medical provider may balance bill for services provided. For example, authorized medical providers in workers’ compensation cases may not balance bill at all, Section 440.13(14)(a) Florida Statutes, while providers accepting payments through PIP insurance (motor vehicle accident cases) are limited to balance billing 20% of “allowable charges,” which, in most instances, is significantly less than their on-the-books outstanding charges. Section 627.736(5)a.5 Florida Statutes.

For private health insurance, the terms of the insurance contract itself control the issue, with provisions ranging from zero allowable balance billing to full balance billing. For the most part, these policies allow a small amount of balance billing, again leaving the providers with large uncollectible accounts receivable.

Our law firm sees a fair amount of inappropriate balance billing, but less and less each day as medical providers become more aware of the dangers associated with the practice. Good thing.

Contact us at 866-785-GALE or by email to learn your legal rights.

Jeffrey P. Gale, P.A. is a South Florida based law firm committed to the judicial system and to representing and obtaining justice for individuals – the poor, the injured, the forgotten, the voiceless, the defenseless and the damned, and to protecting the rights of such people from corporate and government oppression. We do not represent government, corporations or large business interests.

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5 responses to “Prohibited Balance Billing in Florida”

  1. Gary Whitmore says:

    I don’t know if I am being subjected to balanced billing my the Brevard Pathology office in Cocoa Beach, Florida.

    I was billed $285.68 by Brevard Pathology on 9/26/2014 for tissue exam from a prostate biopsy by Dr. Scott Sittler. The biopsy was performed on 5/22/2014. I have Blue Cross Blue Shield (BCBS) insurance and a claim dated 10/27/2015 shows that:

    Provider Billed $1,008.00
    Member Discount -$722.34
    Net Amount Charged $285.66
    Florida Blue Paid $257.09
    Member Responsibility $28.57

    There was confusion with this bill so I sent Brevard Pathology a check for $285.68 on 10/25/2014 not realizing that BCBS paid $257.09 and my responsibility was only $28.57. I never received a bill from Brevard Pathology stating I owed $28.57.

    On 9/5/2015, I received a collection notice from the Collection Information Bureau of Lake Worth, Florida stating I owed Brevard Pathology $28.59 for services rendered on 5/22/2014. Again, I never received a bill from Brevard Pathology for the amount of $28.59.

    Also I noted that there was a $0.02 increase in the billing amount sent to me. $285.66 verses $285.68 and $28.57 verses $28.59.

    So I paid Brevard Pathology $285.68 and BCBS paid Brevard Pathology $257.09 for a total of $542.77. I’m of the understanding that the total charge for their services done on 5/22/2014 was $286.66 according to my BCBS account.

    Is this a case where Brevard Pathology is billing twice for the same services? Don’t know if that’s legal in the State of Florida.

    I’m sending the collection agency a written notice on 9/8/2015 that I dispute this debt as being invalid.

  2. Michele DuBois-Payne says:

    I have a problem with provider charging me unreasonable amounts for emergency room visits when I was in pain for an ovarian tumor and then prescribed pain meds and sent me home, twice. The third time they admitted me because I was in so much pain. Needless to say I had Florida blue policy and thought it was covered by my plan. Come to find out this doctor or doctors and hospital. Physicians Regional, are out of network and BCBS does not contract with them. BCBS paid them what they could legally.No one ever asked us or said anything about this. This also happened with the lab where my malignancy was found after surgery by a doctor at Lee memorial.It was a private lab they use. I am really discouraged and cannot pay these bills. I am in cancer treatment right now receiving chemotherapy and bills are piling up. I am out of work as well. What can I do? I moved here from New York in July 2015. Diagnosed in Nov 2015 with stage 2 ovarian cancer.
    Thank YOU.

  3. Angelica says:

    I have an issue with the pharmacy sending me an bill that was paid and now my insurance decided not to pay it. I have the Mirena IUD implanted in me. I had the prescription done on 9.12.16. BCBSFL paid it $860.05 on 9.23.16 and my doctor received the IUD. I had an zero balance as to why I was able to pick up the prescription. The IUD is inserted in me now. Well now the insurance it’s 12.1.16 long after the IUD is inserted in me and I have an bill of $860.05 that was once paid. Not like I can return the IUD or was even given an option to not get the IUD. Who would not go ahead an get an IUD that is completely paid for? So, now I’m stuck with either paying the full balance or being sent to collections. Does this falls under the Balance Billing for Florida

  4. Leilani says:

    I was injured @ work in Alabama. A dentist in Florida where I live has been treating me for almost 10 years. In may the Alabama workers comp stopped paying @ 100% due to what the dentist charges & now the dentist is billing me for the $2,000 balance left from the workers comp not paying 100% for my last visit. Is this legal balance billing? I researched that it is illegal to balance bill in Florida but due to my injury occurring in Alabama I’m unsure if this changes this.

    • Jeffrey P. Gale, P.A. says:

      That is a very good question, one to which I do not have an immediate answer. I could get the answer with a little research, but I would have to charge for my time. However, if it turns out that the Florida doctor is balance billing, he may ultimately have to reimburse you for any attorney’s fees you’ve incurred.
      Yours truly,
      Jeffrey P. Gale

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