June 14, 2017

Florida Board of Medicine Prohibits Dietitians and Nutritionists From Engaging in Balance Billing

Holland & Knight Healthcare Blog
Eddie Williams III

The Florida Board of Medicine has amended Rule 64B8-44.003, Florida Administrative Code (effective June 5, 2017) to prohibit dietitians and nutritionists from balance billing. The practice of balance billing is where a health care provider bills a patient for the difference between what the patient’s insurance company agrees to pay on a claim and what the provider charges for the service. For certain covered services, Florida law prohibits a provider from collecting or attempting to collect any amount not paid by an insurer other than copayments, coinsurance, and deductibles.

This prohibition applies to emergency services provided by an out-of-network provider and non-emergency services provided by an out-of-network provider at an in-network facility when the patient did not have an opportunity to choose an in-network provider. When the balance billing prohibition applies, reimbursement to the provider is limited to the provider’s charges, the usual and customary charges for similar services in the community where the services are provided, or the charge mutually agreed to by the insurer and the health care provider.

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