Florida HMO Ordered to Pay $1.5 Million to Doctors

Blue Cross and Blue Shield news...health care at risk for the sake of saving some money...BD

 

MIAMI, FL -- (MARKET WIRE) -- 05/01/07 --
Under the Florida HMO Act, when an HMO member is admitted to any Florida hospital, all pathology tests ordered by a physician must be covered by the HMO, including technical and professional clinical pathology laboratory services. The costs of such tests are divided into two components: technical, which includes the hospital's labs and equipment; and professional, which includes the services of the physician supervising and interpreting the tests.

In 1999 Florida's largest health insurer, Blue Cross and Blue Shield of Florida (Health Options HMO), made a statewide business decision to stop paying all hospital pathologists for the professional component of clinical pathology medical services. Their decision would save them $4.1 million per year. In 2005, after years of unsuccessfully attempting to collect their fees from Health Options, Florida Pathology Services filed suit in Miami Dade County 11th Circuit Court on behalf of Palmetto General Hospital and Coral Gables Hospital, citing the Florida HMO Act and the American Medical Association (AMA) guidelines as their source for restitution.

On April 16, 2007, the weeklong "landmark" case began. "This case is really about quality healthcare," said Ervin A. Gonzalez, attorney for the Plaintiffs. "The doctors need to get paid for supervising and interpreting lab results. If they don't get paid, the healthcare system will begin seeing an increase in negligence and a decrease in physicians who are willing to work in Florida. The patient will ultimately be the one that loses."

"This is the first case of its kind and is a landmark case," said Gonzalez. "The judge's decision that payment was required by laws will impact all cases in Florida and other states with similar cases." Gonzalez is currently representing 11 other hospital pathology groups around the state -- all individually scheduled for trial in 2007 before Judge Wilson.

Source: Florida HMO Ordered to Pay $1.5 Million to Doctors @ SYS-CON Media