Healthcare GIC Builds Florida Provider Network Main Menu
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MAY 2006 - Balance Billing Concerns Continue - When seeking medical care, members living beyond the borders of Massachusetts often face the threat of being held responsible for thousands of dollars in unpaid medical bills.
Known as balance billing, out-of-state retirees can end up in the middle of a tug of war between the local hospital/doctor and the Group Insurance Commission (GIC) over the proper cost for medical care. In Massachusetts, state law requires medical providers to accept the fee from the GIC as payment in full. A recent example of this problem came from Florida, where Association member Jerrold Patz found himself facing an $11,000 unpaid hospital bill. Patz, a 1992 retiree of the Department of Environmental Protection, had to be rushed to St. Lukes Hospital in Jacksonville, as he suffered from a burst appendix. Following his surgery and hospital stay, a bill of some $20,000 was submitted to the GIC via UniCare. Under UniCare's fee schedule, the allowable charges totaled $9,000, leaving the $11,000 unpaid balance. In Massachusetts, the hospital would have had to accept the $9,000 payment as payment in full. However, since Florida does not have a law prohibiting balance billing, St. Lukes began billing Patz for the unpaid charges. At that point, he contacted the Association and enlisted the help of Insurance Coordinator Cheryl Stillman, who was able to get the charges resubmitted to the GIC for review. "As a result of Cheryl's work, the GIC picked up another $6,000 of the bill. Unfortunately, Jerry Patz was left having to pay the additional $5,000 balance that remained. The hospital just would not budge," explained Association President Ralph White. Network Expands Unknown to Patz, at the time of his emergency surgery, was a new program initiated by the GIC, in which UniCare is forming a national network of providers, which accept its fee schedule. If Patz had been rushed to Jacksonville Memorial Hospital, instead of St. Lukes, the payment made by UniCare would have been accepted as payment in full. In recent years, the GIC has moved to eliminate the balance billing woes of out of state retirees, while also helping to control its own costs, by developing a national network of preferred providers. In Jacksonville alone, five hospitals are included in the UniCare network. Across Florida, hundreds of hospitals, physicians and providers have signed onto the growing network. Similar arrangements exist in other states as well. "The GIC and UniCare have done a very good job in building an out of state network. Unfortunately, Mr. Patz ended up at one of the few hospitals in Jacksonville that won't join the network," said Stillman. "Enrollment in the network is open to any provider who agrees to accept the fee schedule." "We encourage all out-of-state members enrolled in the GIC Indemnity Plan to check with UniCare to see if your medical providers are enrolled in the Network. If not, you are encouraged to talk to your doctor about joining." Members with Internet access can go to www.unicare.com and check under the "Plans & Providers" section to see if your doctor/hospital is enrolled. You can also call the toll-free number found on your GIC Insurance card. |
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