SB 162-Relating to Payment of Healthcare Claims

On Tuesday, December 5th, SB 162, by Senator Greg Steube (R-Sarasota) was heard before the Senate Committee on Banking and Insurance and passed by a vote of 10 yeas to 0 nays. AIF’s Senior Vice President of State and Federal Affairs, Brewster Bevis, spoke in opposition to this bill.

This bill prohibits health insurers and health maintenance organizations (HMOs) from retroactively denying a claim at any time if the insurer or HMO verified the eligibility of an insured or subscriber at the time of treatment and provided an authorization number, regardless of if the insured has paid their premiums prior to that claim rendering them ineligible for coverage.

SB 162 will go on to the Senate Committee on Health Policy for its next hearing.

AIF opposes legislation requiring insurers to pay claims for all people, even those that have not paid their premiums because it would raise costs on employers who would be required to pay health care expenses of people who are no longer employees, and consumers would bear the burden of paying the high costs of fraud, waste and abuse that would occur in the system.

SB 98-Relating to Health Insurer Authorization

On Tuesday, December 5th, SB 98, by Senator Greg Steube (R-Sarasota) was heard before the Senate Committee on Judiciary and passed 10 yeas to 0 nays. AIF’s Senior Vice President of State and Federal Affairs, Brewster Bevis, stood in opposition to this bill.

This legislation creates a standard process for the approval or denial of (1) prior authorizations and (2) step therapy (“fail-first”) protocol exceptions. Currently, the many health insurance carriers in Florida employ robust policy product offerings containing medically-proven prior-authorization and step-therapy programs designed to reflect the protocols and standards of care, advanced and adopted by a vast array of specialty physicians based on their latest evidence-based research. These procedures and protocols allow for the use of the safest, most appropriate and most cost-effective drug, and permit progressing to other, more costly drugs with more sophisticated interactions and side-effects, in accordance with FDA approvals.

SB 98 will move on to the Senate Committee on Rules.

AIF opposes this legislation as it would force insurers and consumers to purchase the most expensive drugs and treatments even when equally effective therapies are available at much lower costs.