March 5, 2024

Workers' comp insurers fight hospital payment plan

Several workers’ compensation insurance companies are challenging a new state proposal that would set payment amounts to hospitals for inpatient care.

Normandy Insurance Co., Zenith Insurance Co., Bridgefield Employers Insurance Co., Bridgefield Casualty Insurance Co., BusinessFirst Insurance Co. and RetailFirst Insurance Co. filed the case at the state Division of Administrative Hearings against the Florida Department of Financial Services’ Division of Workers’ Compensation.

The case centers, at least in part, on a proposed rule setting what are known as “maximum reimbursement allowances” that workers’ compensation insurers would pay to hospitals for inpatient care.

The challenge said the proposed rule would lead to paying $7,000 a day for inpatients who do not need surgery or intensive care; $11,000 a day for patients who need surgery; and $13,000 a day for intensive-care unit treatment.

The challenge contends that the proposed rule and the methodology are “arbitrary and capricious” and conflict with a state law.

“While the MRAs (maximum reimbursement allowances) may be efficient, neither the DWC (Division of Workers’ Compensation) nor the hospitals defend them as ‘reasonable,’” the insurance companies argued in part of the case.

“The DWC did not compare the proposed MRAs to the levels of reimbursement by other payors or programs, as required by law. They should accomplish this by comparing Medicare, private health payments in Florida or the other state workers’ compensation programs. … Because the DWC ignored this statutory mandate, the MRAs are invalid.”

The case was filed Monday at the Division of Administrative Hearings and has been assigned to Administrative Law Judge Darren Schwartz.

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