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FMA agenda: Florida’s doctors want insurance companies to get out of their way

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The Florida Medical Association released its legislative priorities for 2017; removing interference by insurance companies in doctor’s decisions about patient care is prominent on the list.

“The FMA believes in promoting the highest standards of medical care, maintaining choice for patients in a free-market health care system, and preserving the sacred relationship between patients and their physicians,” the document says.

“The best way to achieve these objectives is by advocating for public policy that establishes fair and transparent insurance markets, reduces onerous red tape, and eliminates bureaucratic hassles that impede care and harm patients.”

First, the priority is a direct primary care system, described as “an alternative to the traditional fee-for-service model in which patients are charged a simple, affordable flat monthly fee for comprehensive coverage of all primary care services.”

The idea is to prevent chronic illnesses and reduce administrative expenses. Primary care doctors prefer this system because it lets them spend more time with patients and provides better care for less money, the document says.

It is the only objective for which the FMA mentions formal legislation — HB 161, by Republican Danny Burgess, and the companion SB 240, by Republican Tom Lee.

The bills would authorize such arrangements, specifying that they do not constitute insurance policies subject to oversight by the Office of Insurance Regulation.

Second, the FMA supports allowing doctors to override “fail first” policies by which, it says, insurers decide which drugs doctors should try first.

“This causes delays in care that can lead to unnecessary hospitalizations and sometimes devastating consequences for patients,” the FMA says.

“Florida needs legislation that allows physicians and patients to override step therapy protocols when deemed medically necessary and in patients’ best interests.”

Next is legislation to standardize the system for obtaining insurers’ authorization before doctors can prescribe medication, refer patients to specialists, and order testing or other treatments.

The document says doctors spend two hours on paperwork, such as obtaining these approvals, for every hour spent with patients.

The FMA wants legislation to require insurance companies to broaden their networks of approved doctors and hospitals, to give patients more choice, and to expand the availability of out-of-network care.

The organization decried “bait and switch” tactics, “whereby health plans publish inaccurate information about their provider networks in order to attract premium dollars.”

The FMA seeks to ban insurers from retroactively denying payment for services they previously approved. Doctors, the organization says, are “plagued” by underpayment, lack of payment, and retroactive denials by insurance companies.

Another priority is legislation similar to that passed in other states limiting doctor certification requirements to standard continuing education after initial board certification.


Michael Moline is a former assistant managing editor of The National Law Journal and managing editor of the San Francisco Daily Journal. Previously, he reported on politics and the courts in Tallahassee for United Press International. He is a graduate of Florida State University, where he served as editor of the Florida Flambeau. His family’s roots in Jackson County date back many generations.

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