Tackling contentious insurance issues

Published: 2009-12-29 11:54:52
Author: BEATRICE E. GARCIA | Miami Herald | December 28, 2009

As the state insurance consumer advocate, Sean Shaw has a full plate as the 2010 legislative session looms just two months away.

He will present regulators and legislators recommendations to improve the claims process for homeowners and possibly increase supervision for public adjusters. The recommendations are the product of several meetings of the Claims Resolution Roundtable, which Shaw hosted this summer and fall with insurers, contractors, adjusters and consumers.

The group has one more meeting the first week in January and recommendations to legislators have to be ready by the end of January.

He also plans to tackle a contentious healthcare insurance issue that pits doctors against consumers: the practice of out-of-network doctors billing patients for services their medical plans won't cover. Many consumers, having carefully chosen doctors and hospitals for tests and medical procedures covered by their insurers, are shocked when they receive additional bills for hundreds -- sometimes thousands -- of dollars.

"This is my No. 1 issue for the upcoming legislative session. This is something that unconscionable. When this happens, it's just devastating. As you know, these aren't small bills.''

The practice was banned for doctors and providers in health maintenance organizations. Now Shaw would to bring the same prohibition to physician provider networks. Such a move will require legislation. Shaw says he doesn't have a sponsor for a bill yet.

Shaw was appointed to his job by Alex Sink, the state's chief financial officer, in October 2008. It's his first job in the public sector, but he's not new to public service.

Shaw draws his inspiration from his father, retired Florida Supreme Court Chief Justice Leander J. Shaw. The elder Shaw was the first African-American to be appointed to the state's highest court. He also served as an assistant public defender during his career as a public servant.

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