STORY TOOLS

• E-mail story
• iPod friendly
• Printer friendly

Tell us about it

• What would you add to this story? Tell us what we missed.
• Do you have photos from this event? Documents we need to see? Share with us.
• Upload photos & videos
• More ways to get your stuff online and in the paper.

More Latest News

• Collier schools summer bus schedules announced
• Report: UCF players tell of intense workout, coach cursing before Plancher's death
• Traffic enforcement locations for Collier, Lee

Share and Enjoy [?]

Personal injury protection auto insurance is required until Monday.

After that, Florida drivers can drop coverage.

Come Dec. 1, they better have it again. Then new PIP regulations may kick in Jan. 15.

Feeling a little whiplashed?

Administrators at Florida hospitals, their lobbyists, and medical clinic owners are grasping to evaluate a just-released proposal regarding personal injury protection insurance in time for legislative committee meetings Tuesday in Tallahassee.

That’s when they can voice their views on a whirlwind, last-ditch plan by state lawmakers to reinstate the insurance mandate that Florida drivers carry a minimum of $10,000 in coverage, also called no-fault. The coverage pays medical expenses and other costs regardless of who is at fault in an auto accident.

The state Legislature convenes Wednesday for a special budget-cutting session and the new PIP proposal is expected to be added to the agenda.

The issue is critical for the hospital industry because PIP helps to pay medical bills of accident victims, especially when huge numbers of drivers don’t have health insurance as a secondary source of reimbursement for hospitals.

“We want to analyze it,” Rich Rasmussen, spokesman for the Florida Hospital Association, said about the 87-page bill, sent to hospitals to evaluate. “We probably will get responses on Monday.”

Among the major points of the plan is reinstating the $10,000 coverage requirement on Dec. 1. Starting Jan. 15, new PIP regulations would take effect, according to the bill.

Another provision would require medical providers to use a fee schedule for reimbursement at 80 percent of maximum charges.

“We are kind of unclear of how that would work,” Rasmussen said of the fee schedule.

The plan would cap emergency room care to 75 percent of customary charges and would reserve $5,000 of a driver’s coverage to pay for physicians’ fees in the emergency room or for inpatient care.

“The bottom line to all of this discussion is we have a bill under consideration by the Legislature which a month ago we didn’t have,” Rasmussen said.

The Hospital Association and a long list of health-care providers formed the Coalition to Protect Florida Drivers this past summer to lobby against the Oct. 1 expiration of the law, pointing out how Florida hospitals received $350 million in PIP reimbursement in 2005 for treating auto accident victims.

That source of reimbursement is vital because 40 percent of auto accident patients coming through the emergency room and trauma center don’t have health insurance, according to the coalition.

The Lee Memorial Health System in Lee County received $15 million in PIP payments in 2005 and the NCH Healthcare System saw $1 million in PIP reimbursement that year

Keith Arnold, a lobbyist for Lee Memorial, said what’s being overlooked is that there has been no increase in the PIP minimum requirement since the law was enacted in 1972, yet hospital costs have skyrocketed.

Moreover, the plan of setting aside just $5,000 of the PIP minimum for reimbursing physicians who provide inpatient care exacerbates the plight of the hospitals, he said.

“This is not an ideal solution for hospitals, obviously,” Arnold said. “It’s not even half a loaf for hospitals but it is a few slices of bread, helpful but certainly not ideal.”

What’s certain to make matters worse will be the “three classes of citizens’” that will exist, those in accidents before Oct. 1, those in accidents when PIP isn’t required, and those injured under what comes out of the new regulations, he said.

It’s going to be difficult for drivers to figure out if they have coverage or not.

“It certainly provides for more chaos for a process that is pretty chaotic and cumbersome to begin with,” he said.

Dr. Allen Weiss, president and chief executive officer of the NCH Healthcare System, said it’s important that there is some mandatory requirement for hospitals and the public alike.

“The point of insurance is to share the risk and without that we lose a safety net for everyone,” Weiss said.

The proposal that $5,000 of the minimum be set aside to reimburse physicians is trivial, he said.

“It won’t cover a fraction of what it costs to treat patients, for both the physicians and the hospitals,” he said.

If the problem is fraud in the system, go after the people who perpetuate the fraud, Weiss said.

“Everyone shouldn’t suffer because of some people abusing the system,” he said.

Officials at the 83-bed Physicians Regional Medical Center-Pine Ridge, said the potential loss of the PIP requirement or changes to the law would have minimal effect on that hospital compared to the 681-bed NCH hospital system.

“We are a much smaller hospital and we don’t have trauma (patients),” said Lisa Gardiner, spokeswoman for Physicians Regional. “It is just not affecting us as the larger hospitals.”

The insurance industry has cited fraud with PIP in its quest to eliminate it, pointing to bogus claims filed by questionable clinics and how those costs drive up premiums for everyone. To help crack down on fraud, the new PIP bill would set aside $2 million to law enforcement for prosecuting illegal PIP activity.

Southwest Florida clinic operators say they don’t see people trying to file bogus claims compared to what happens on the state’s east coast.

“My gut feeling (is that the fraud) is minimal here,” said Dr. Richard Abood, owner of Collier Urgent Care Center in North Naples. “It’s night and day difference between east coast medicine and west coast medicine in Florida.”

His urgent care center does bill auto insurance for PIP reimbursement but many clinics won’t. Some of his patients, however, don’t want their auto carrier billed because they don’t want to file a claim and see their premiums rise.

The bottom line is his clinic won’t be hurt if PIP isn’t reinstated, he said.

“It’s going to be painful for hospitals,” Abood said.