This guide addresses the 10 most frequently asked questions about Florida medical billing laws, providing clear and up-to-date answers. Read on to clarify balance billing in Florida, patients’ rights under Florida laws, and terms like ‘non-compliant patient’.
1. How to fight balance billing in Florida?
To combat balance billing in Florida, once you have read the bill, you may ask for an itemized statement that will provide a breakdown of all charges to see if there are any errors. The second step is to check your insurance policy to verify coverage, obtain all the billing records, and contact your insurance company. If needed, report a complaint to the Florida Department of Financial Services. You can also get assistance from a medical attorney or the state’s No Surprises Act protections.
Here’s a detailed breakdown of the crucial steps to follow:
- Ask for an itemized bill:
Request a bill detailing all services and their specific medical codes. A maximum number of bills have errors in the form of incorrect codes or charges. - Request the contract:
If you have a written agreement, you are liable to pay. Otherwise, you’re not obliged to pay anything. - Do some personal research:
Use the Internet to find out the charges for the services rendered. This will give you an idea of the market price and allow you to negotiate accordingly. - Reach out to your insurance:
Check your EOB to see if the particular procedure is covered. In case it’s covered as per your EOB and the company refuses to pay, you have two options. First, reach out to the National Association of Insurance Commissioners and contact your state to file and appeal.
2. What information should be included in a patient statement?
A patient statement ought to provide plain contact information in case of billing concerns. Additionally, it must incorporate the service date, explanation of services rendered, total charge, insurance payments or adjustments made, and remaining patient balance.
Here’s a more detailed breakdown:
- Patient and Provider Information:
Patient and providers complete name, address, phone number, email address, and website of the medical practice. - Service Details:
Date of service, description, charges, codes, and insurance information. - Payment Information:
Total amount due, payment due date, payment instructions, and contact information for billing questions. - Additional Information:
Statement number, Account number, and prior statements.
3. What are some key rights that patients are entitled to under healthcare laws?
According to state and federal laws, patients are entitled to receive timely information regarding their care, exercise informed decisions, refuse treatment, and obtain copies of their medical records. Further, the rights to informed consent, second opinions, continuity of care, and advance directives are safeguarded by law under a patient’s rights. Physicians must comply with these rights.
Here is a list of essential patient rights:
- Right to be treated with respect and dignity
- Right to information
- Right to make informed decisions
- Right to refuse treatment
- Right to access medical records
- Right to privacy and confidentiality
- Right to continuity of care
- Right to a second opinion
- Right to advance directives
4. How long after service can a doctor bill you in Florida?
In Florida, physicians generally have a maximum of five years to bill for medical services. Insurance companies frequently require claims to be submitted within a time frame, typically within 90 days to one year following service.
Here are some nuances, though:
- Medical facilities like a hospital should file claims within a short time of 6 months to a year. If they are not able to file during this time, you’re still responsible for paying.
- After five years, a hospital or other facility can still attempt to collect the bill, but now they can’t sue you.
5. What term is used to describe a patient who does not follow the medical advice given?
The term used is “noncompliant patient.” This describes a patient who does not follow prescribed treatments, medications, or lifestyle recommendations provided by their healthcare provider.
Some other frequently used related terms in this regard are:
- Non-compliant: A Patient who chooses not to follow the doctor’s advice by choice.
- Non-adherent: A Patient who doesn’t follow the treatment plan due to reasons beyond their control.
- Treatment nonadherence: Any failure to follow a treatment plan.
- Discharge against medical advice (DAMA): A patient who leaves the hospital before the doctor recommends it.
Some more related questions to Florida Medical Billing
6. Can a doctor bill you 2 years later in Florida?
Yes, a physician can bill you 2 years later in Florida since the statute of limitations for billing physicians usually permits up to five years. Nevertheless, insurance policy timelines and particular contracts may impose lesser timeframes.
7. Which type of patient is not receiving care in an ambulatory care center?
A patient admitted for an overnight hospital stay or inpatient surgery is not being treated in an ambulatory center, since ambulatory centers only offer same-day, outpatient procedures.
8. Who has the primary responsibility for setting the overall direction of the hospital?
The hospital’s board of directors is mainly responsible for establishing the overall direction and ensuring strategic planning, financial control, and compliance with regulations.
9. What is one legal requirement healthcare facilities must follow in Florida?
One legal mandate in Florida is that healthcare facilities should provide patients with a good-faith estimate of charges if requested and prominently post patient rights and responsibilities.
10. What are the three key statements that guide the delivery of care in a clinical facility?
The mission, vision, and values statements guide the delivery of care in a clinical facility, ensuring that patient care aligns with the facility’s core principles and goals.
