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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to savings and out -of-pocket expenses 2
in health insurance; amending ss. 395.107, 395.301, 3
458.323, 459.012, 460.41, and 461.009, F.S.; requiring 4
certain licensed facilities and physicians to provide 5
specific pricing and cost -obligation information to 6
patients; amending s. 627.6471, F.S.; requiring a 7
health insurer, effective on a specified date, to 8
apply the payment for a service that a nonpreferre d 9
provider provided to an insured toward the insured's 10
deductible and out-of-pocket maximum as if the service 11
had been provided by a preferred provider, if specific 12
conditions are met; providing effective dates. 13
14
Be It Enacted by the Legislature of the State of Florida: 15
16
Section 1. Subsection (3) of section 395.107, Florida 17
Statutes, is amended to read: 18
395.107 Facilities; publishing and posting schedule of 19
charges; penalties; cost-sharing obligation information .— 20
(3)(a) The schedule of charges must describe the medical 21
services in language comprehensible to a layperson. The schedule 22
must include the prices charged to an uninsured person paying 23
for such services by cash, check, credit card, or debit card. 24
(b) The schedule must be posted in a co nspicuous place in 25
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the reception area and must include, but is not limited to, the 26
50 services most frequently provided. The schedule may group 27
services by three price levels, listing services in each price 28
level. The posting may be a sign, which must be a t least 15 29
square feet in size, or may be through an electronic messaging 30
board. 31
(c) If a facility is affiliated with a licensed hospital 32
under this chapter, the schedule must include text that notifies 33
the insured patients whether the charges for medica l services 34
received at the center will be the same as, or more than, 35
charges for medical services received at the affiliated 36
hospital. 37
(d) The text notifying the patient of the schedule of 38
charges shall be in a font size equal to or greater than the 39
font size used for prices and must be in a contrasting color. 40
The text that notifies the insured patients whether the charges 41
for medical services received at the center will be the same as, 42
or more than, charges for medical services received at the 43
affiliated hospital shall be included in all media and Internet 44
advertisements for the center and in language comprehensible to 45
a layperson. 46
(e) At the point of sale, each center shall disclose to 47
the patient whether his or her cost -sharing obligation exceeds 48
the retail price of services in the absence of health insurance 49
coverage. 50
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Section 2. Subsection (7) is added to section 395.301, 51
Florida Statutes, to read: 52
395.301 Price transparency; itemized patient statement or 53
bill; patient admission status notificat ion.— 54
(7) A licensed facility shall disclose to a patient or a 55
prospective patient whether his or her cost -sharing 56
responsibilities exceed the retail price of services in the 57
absence of health insurance coverage. 58
Section 3. Section 458.323, Florida S tatutes, is amended 59
to read: 60
458.323 Itemized patient billing. — 61
(1) Whenever a physician licensed under this chapter 62
renders professional services to a patient, the physician is 63
required, upon request, to submit to the patient, the patient's 64
insurer, or the administrative agency for any federal or state 65
health program under which the patient is entitled to benefits 66
an itemized statement of the specific services rendered and the 67
charge for each, no later than the physician's next regular 68
billing cycle which follows the fifth day after the rendering of 69
professional services. A physician may not condition the 70
furnishing of an itemized statement upon prior payment of the 71
bill. 72
(2) Upon request, and on or before the day of services 73
being rendered, a physician shall provide an insured patient 74
with information regarding the applicable Current Procedural 75
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Terminology (CPT) codes for the scheduled services and the 76
physician's retail price in the absence of health insurance 77
coverage for the scheduled ser vices. 78
Section 4. Section 459.012, Florida Statutes, is amended 79
to read: 80
459.012 Itemized patient statement. — 81
(1) Whenever an osteopathic physician licensed under this 82
chapter renders professional services to a patient, the 83
osteopathic physician is required, upon request, to submit to 84
the patient, the patient's insurer, or the administrative agency 85
for any federal or state health program under which the patient 86
is entitled to benefits an itemized statement of the specific 87
services rendered and the c harge for each, no later than the 88
osteopathic physician's next regular billing cycle which follows 89
the fifth day after the rendering of professional services. An 90
osteopathic physician may not condition the furnishing of an 91
itemized statement upon prior pay ment of the bill. 92
(2) Whenever the itemized statement is submitted to the 93
patient's insurer or the administrative agency, a copy of the 94
itemized statement shall simultaneously be provided to the 95
patient. Such copy of the itemized statement which is sent to 96
the patient shall, in boldfaced letters, state that: "THIS IS A 97
DUPLICATE COPY OF A STATEMENT SUBMITTED TO YOUR INSURER OR OTHER 98
AGENCY." 99
(3) Upon request, and on or before the day of services 100
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being rendered, an osteopathic physician shall provide an 101
insured patient with information regarding the applicable 102
Current Procedural Terminology ( CPT) codes for the scheduled 103
services and the physician's retail price in the absence of 104
health insurance coverage for the scheduled services. 105
Section 5. Section 460.41, Florida Statutes, is amended to 106
read: 107
460.41 Itemized patient billing ; cost-sharing obligation 108
information.— 109
(1) Whenever a chiropractic physician licensed under this 110
chapter renders professional services to a patient, the 111
chiropractic physicia n shall submit to the patient, to the 112
patient's insurer, or to the administrative agency for any 113
federal or state health program under which the patient is 114
entitled to benefits an itemized statement of the specific 115
services rendered and the charge for each , no later than the 116
chiropractic physician's next regular billing cycle which 117
follows the fifth day after the rendering of professional 118
services. A chiropractic physician may not condition the 119
furnishing of an itemized statement upon prior payment of the 120
bill. 121
(2) At the point of sale, a chiropractic physician shall 122
disclose to a patient whether his or her cost -sharing obligation 123
exceeds the retail price of professional services in the absence 124
of health insurance coverage. 125
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Section 6. Section 461.009, Florida Statutes, is amended 126
to read: 127
461.009 Itemized patient billing ; cost-sharing obligation 128
information.— 129
(1) Whenever a podiatric physician licensed under this 130
chapter renders professional services to a patient, the 131
podiatric physician is required , upon request, to submit to the 132
patient, to the patient's insurer, or to the administrative 133
agency for any federal or state health program under which the 134
patient is entitled to benefits, an itemized statement of the 135
specific services rendered and the cha rge for each, no later 136
than the podiatric physician's next regular billing cycle which 137
follows the fifth day after the rendering of professional 138
services. A podiatric physician may not condition the furnishing 139
of an itemized statement upon prior payment of the bill. 140
(2) At the point of sale, a podiatric physician shall 141
disclose to the patient whether his or her cost -sharing 142
obligation exceeds the retail price of professional services in 143
the absence of health insurance coverage. 144
Section 7. Effective Ja nuary 1, 2024, subsection (7) of 145
section 627.6471, Florida Statutes, is renumbered as subsection 146
(8), subsection (4) is amended, a new subsection (7) is added to 147
that section, to read: 148
627.6471 Contracts for reduced rates of payment; 149
limitations; coinsur ance and deductibles. — 150
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(4) Except as otherwise provided in subsection (7), any 151
policy that provides schedules of payments for services rendered 152
provided by preferred providers that differ from the schedules 153
of payments for services rendered provided by nonpreferred 154
providers is subject to the following limitations: 155
(a) The amount of any annual deductible per covered person 156
or per family for treatment in a facility that is not a 157
preferred provider may not exceed four times the amount of a 158
corresponding annual deductible for treatment in a facility that 159
is a preferred provider. 160
(b) If the policy has no deductible for treatment in a 161
preferred provider facility, the deductible for treatment 162
received in a facility that is not a preferred provider facility 163
may not exceed $500 per covered person per visit. 164
(c) The amount of any annual deductible per covered person 165
or per family for treatment, other than inpatient treatment, by 166
a provider that is not a preferred provider may not exceed four 167
times the amount of a corresponding annual deductible for 168
treatment, other than inpatient treatment, by a preferred 169
provider. 170
(d) If the policy has no deductible for treatment by a 171
preferred provider, the annual deductible for treatment received 172
from a provider which is n ot a preferred provider shall not 173
exceed $500 per covered person. 174
(e) The percentage amount of any coinsurance to be paid by 175
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an insured to a provider that is not a preferred provider may 176
not exceed by more than 50 percentage points the percentage 177
amount of any coinsurance payment to be paid to a preferred 178
provider. 179
(f) The amount of any deductible and payment of 180
coinsurance paid by the insured must be applied to the reduced 181
charge negotiated between the insurer and the preferred 182
provider. 183
(g) Notwithstanding the limitations of deductibles and 184
coinsurance provisions in this section, an insurer may require 185
the insured to pay a reasonable copayment per visit for 186
inpatient or outpatient services. 187
(h) If any service or treatment is not within the scope of 188
services rendered provided by the network of preferred 189
providers, but is within the scope of services or treatment 190
covered by the policy, the service or treatment shall be 191
reimbursed at a rate not less than 10 percentage points lower 192
than the percentage r ate paid to preferred providers. The 193
reimbursement rate must be applied to the usual and customary 194
charges in the area. 195
(7) An insurer issuing a health insurance policy in this 196
state must apply the payment for a service that a nonpreferred 197
provider rendered to an insured toward the insured's deductible 198
and out-of-pocket maximum as if the service had been rendered by 199
a preferred provider, if all of the following apply: 200
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(a) The insured requests that the insurer apply the 201
payment for the service the nonpre ferred provider rendered to 202
the insured toward the insured's deductible and out -of-pocket 203
maximum. 204
(b) The service the nonpreferred provider rendered to the 205
insured is a service within the scope of services covered under 206
the insured's policy. 207
(c) The amount the nonpreferred provider charged the 208
insured for the service is the same or less than: 209
1. The lowest cost that the insured's preferred provider 210
network charges for the service in the relevant rating area; or 211
2. The 25th percentile of the statewide average amount for 212
the service, based on data reported on the Agency for Health 213
Care Administration's Internet -based platform under s. 214
408.05(3)(c). 215
Section 8. Except as otherwise expressly provided in this 216
act, this act shall take effect July 1, 2023. 217