Florida Senate - 2015 SB 1240
By Senator Richter
23-00609B-15 20151240__
1 A bill to be entitled
2 An act relating to damages recoverable for cost of
3 medical or health care services; creating s. 768.755,
4 F.S.; providing for the calculation of an award of
5 damages for certain medical or health care services
6 paid or owed by a claimant or a governmental or
7 commercial insurance payor, subject to certain
8 restrictions; specifying evidence that a party may
9 introduce for certain medical or health care services
10 provided to a claimant for which an outstanding
11 balance is claimed to be due to a provider; providing
12 that individual contracts between providers and
13 licensed commercial insurers or licensed health
14 maintenance organizations are not subject to discovery
15 or disclosure and are not admissible into evidence in
16 certain actions; providing that the amount of a lien
17 or subrogation claim asserted by Medicaid, Medicare,
18 or a payor regulated under the Florida Insurance Code
19 for certain past medical expenses, in addition to the
20 amount of copayments or deductibles payable by the
21 claimant, is the maximum amount recoverable and
22 admissible into evidence under certain circumstances;
23 providing applicability; providing a directive to the
24 Division of Law Revision and Information; providing an
25 effective date.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Section 768.755, Florida Statutes, is created to
30 read:
31 768.755 Damages recoverable for cost of medical or health
32 care services; evidence of amount of damages; applicability.—
33 (1) In any personal injury or wrongful death action to
34 which this part applies, damages for the cost of medical or
35 health care services provided to a claimant shall be calculated
36 as follows:
37 (a) For medical or health care services provided by a
38 particular health care provider to the claimant which the
39 claimant paid for and for which an outstanding balance is not
40 due the provider, the actual amount remitted to the provider is
41 the maximum amount recoverable. Any difference between the
42 amount originally billed by the provider and the actual amount
43 remitted to the provider is not recoverable or admissible into
44 evidence. In an action in which there is more than one health
45 care provider who has provided medical or health care services
46 to the claimant, the evidence admissible under this subsection
47 as to a provider with no outstanding balance due may not be used
48 as evidence regarding the reasonableness of the amounts billed
49 by any of the other health care providers who have an
50 outstanding balance due.
51 (b) For medical or health care services provided by a
52 particular health care provider to the claimant which a
53 governmental or commercial insurance payor paid for and for
54 which an outstanding balance is not due the provider, other than
55 a copay or deductible owed by the claimant, the actual amount
56 remitted to the provider by the governmental or commercial
57 insurance payor and any copay or deductible owed by the claimant
58 are the maximum amount recoverable. Any difference between the
59 amount originally billed by the provider and the actual amount
60 remitted to the provider or due from the claimant for a copay or
61 deductible is not recoverable or admissible into evidence. In an
62 action in which there is more than one health care provider who
63 has provided medical or health care services to the claimant,
64 the evidence admissible under this subsection as to a provider
65 with no outstanding balance due may not be used as evidence
66 regarding the reasonableness of the amounts billed by any of the
67 other health care providers who have an outstanding balance due.
68 (c) For medical or health care services provided to the
69 claimant for which an outstanding balance is claimed to be due
70 the provider, the parties may introduce into evidence:
71 1. Amounts the provider routinely accepts as payment from
72 governmental or commercial insurance payors for identical or
73 substantially similar medical or health care services.
74 2. Amounts the provider billed for the medical or health
75 care services provided to the claimant, including those amounts
76 billed under an agreement between the provider and the claimant
77 or the claimant’s representative.
78 3. Amounts the provider received as compensation, if any,
79 for the sale of an agreement between the provider and the
80 claimant or the claimant’s representative under which the
81 medical or health care services were provided to the claimant.
82 (2) Individual contracts between providers and licensed
83 commercial insurers or licensed health maintenance organizations
84 are not subject to discovery or disclosure in an action under
85 this part, and such information is not admissible into evidence
86 in an action to which this section applies.
87 (3) Notwithstanding any provision of this section, if
88 Medicaid, Medicare, or a payor regulated under the Florida
89 Insurance Code has covered or is covering the cost of a
90 claimant’s medical or health care services and has given notice
91 of assertion of a lien or subrogation claim for past medical
92 expenses in the action, the amount of the lien or subrogation
93 claim, in addition to the amount of any copayments or
94 deductibles paid or payable by the claimant, is the maximum
95 amount recoverable and admissible into evidence with respect to
96 the covered medical or health care services.
97 (4) This section applies only to those actions for personal
98 injury or wrongful death to which this part applies arising on
99 or after the effective date of this act. This section has no
100 other application or effect regarding compensation paid to
101 providers of medical or health care services.
102 Section 2. The Division of Law Revision and Information is
103 directed to replace the phrase “the effective date of this act”
104 wherever it occurs in this act with the date the act becomes a
105 law.
106 Section 3. This act shall take effect upon becoming a law.