Posey PIP Proposal Summary

Late on Friday, September 14, the Florida Senate’s lead no-fault/PIP negotiator, Banking and Insurance Chairman Bill Posey, R-Rockledge, sent a new plan to the House that would resucitate the state’s PIP requirement. 

Below is a summary of Senator Posey’s latest proposal and subsequent news coverage of the issue.

Should you have any questions or comments, please do not hesitate to contact this office.

 

Summary of Draft of the Sept. 14 Senator Posey PIP Bill

Reenacts No-Fault Law and PIP Requirement
• Reenacts the No-Fault Law on October 1, 2007 (no period of repeal).
• Maintains requirement for motor vehicle owners to maintain PIP coverage that pays 80% of medical expenses up to $10,000.
• Provides procedures for insurers to send revised premium and coverage changes to policyholders who have renewed coverage without PIP.

Medical Fee Limits for PIP – Allows PIP insurers to limit reimbursement to the following schedule of maximum charges:
• For emergency transport and treatment (ambulance, emergency medical technicians), 200% of Medicare;
• For emergency services and care provided by a hospital, 75% of billed charges;
• For emergency services and care and related hospital inpatient services rendered by a physician, the physician’s usual and customary charges;
• For hospital inpatient services, 200% of Medicare Part A;
• For hospital outpatient services, 200% of Medicare Part A;
• For all other medical services, 200% of Medicare Part B.
• If medical care is not reimbursable under Medicare, the insurer may apply the workers’ compensation fee schedule. If the medical care is not reimbursable under either Medicare or workers’ compensation, the insurer is not required to pay for the care.
• The insurer may not apply any utilization limits that apply under Medicare or workers’ compensation.
• The insurer must reimburse any health care provider rendering services under the scope of their license, regardless of any restriction under Medicare that limits or restricts payments to certain types of health care providers for specified procedures or procedure codes.
• If an insurer limits payment as authorized, the medical provider may not bill the insured for any excess amount, except for amounts that are not covered due to the deductible, coinsurance amount, or maximum policy limits.

Priority of Payment for Physicians Rendering Inpatient Hospital Care
• Upon receiving notice of an injury or claim covered by PIP, the insurer must make reasonable efforts to determine if inpatient hospital care was provided. If such care was provided, the insurer must reserve $5,000 of PIP benefits for payment to physicians rendering inpatient hospital care.
• The amount in reserve may only be used to pay physicians rendering inpatient hospital care until 30 days after the insurer receives notice that the insured received care in a hospital. After this 30-day period, the unclaimed amount of the reserve may be used to pay claims from other providers.
• The required time to pay claims to other providers is tolled for the time period the insurer is required to hold such claims due to this requirement.

Health Care Clinics – PIP would not reimburse treatment by a licensed health care clinic unless the services or treatment are ordered by a physician (or osteopath); or the health care clinic:
• Has a medical director that is a Florida licensed physician, osteopath, or chiropractor;
• Has either been continuously licensed for more than 3 years or is a publicly traded corporation; and
• Provides at least four of the following medical specialties: 1) general medicine; 2) radiography; 3) orthopedic medicine; 4) physical medicine; 5) physical therapy; 6) physical rehabilitation; 7) prescribing or dispensing outpatient prescription medication; 8) laboratory services.

Demand Letter — Increases from 15 days to 30 days for an insurer to pay a claim (with interest and penalty) after a provider has sent a “demand letter” for payment. (A provider may not file suit and potentially collect attorney fees until the end of this time period.)

 

From the Sun-Sentinel

New plan resurrects form of PIP insurance in Florida
Senate, House officials still differ on ideas

By Aaron Deslatte, Tallahassee Bureau

September 15, 2007

TALLAHASSEE

Florida’s no-fault auto insurance law — due to face its demise on Oct. 1 — has been given another fleeting chance at life.

Buoyed by a minor insurrection in the Florida House and behind-the-scenes dealings by Gov. Charlie Crist’s office, the groups fighting over the fate of the state’s personal-injury protection law, or PIP, have launched a last-ditch round of negotiations between insurers, hospitals, medical providers and trial lawyers.

At stake for Florida drivers is a piece of their auto insurance premium that could vanish once their policy expires — or get more expensive if they opt to buy more bodily injury or medical coverage to make up for losing PIP.

After Sept. 30, drivers would no longer be required to pay for PIP, which covers up to $10,000 of their medical expenses and those of their passengers no matter who’s at fault in a wreck.

Insurers like State Farm have been approved for average rate reductions of 16 percent without PIP, while others won’t cut rates at all, according to state records.

Meanwhile, hospitals and other health care providers claim their costs for treating uninsured patients will go up without PIP.

On Friday, the Senate’s lead negotiator, Banking and Insurance Chairman Bill Posey, R-Rockledge, sent a new plan to the House that would resurrect the PIP requirement.

The deal would offer insurers some guarantees on how much they would have to pay for specific injuries, to fight what insurers claim is rampant fraud and overutilization. But it falls well short of the wishes of House Speaker Marco Rubio, R-West Miami, who wants reforms that also include attorney fee caps and other protections for insurers from “frivolous” lawsuits.

“If I say I’m optimistic, that sounds like it’s not cautionary,” Posey said Friday. “That sounds certain, and I’m not certain.”

His House counterpart, Rep. Ellyn Bogdanoff, R-Fort Lauderdale, said she was “a little disappointed” with the proposal, but added that pressure was building to make a deal. She said she was more confident changes could be passed before lawmakers end their Oct. 3-12 special session.

“The sky’s not going to fall if PIP sunsets for a three-day period,” she said.

On another front, a bipartisan group of a dozen House lawmakers is trying to gather enough votes to prod Crist and the Republican leadership to add PIP to the special session.

“Leadership means being in touch with what your body feels is important and making sure there’s a fair process,” said Republican Rep. Kevin Ambler, a Tampa trial lawyer trying to rally lawmakers for an extension.

Rubio spokeswoman Jill Chamberlin said he’s been clear there will be no new life for PIP unless attorney fees are capped and problems that allow patients to overutilize it for unnecessary services are fixed.

“The speaker has been consistent on this issue from day one, going back years, that perpetuation of PIP is a continued license for fraud,” she said.