Florida Statutes
Fla. Stat. § 627.638 (2025)
Direct payment for hospital, medical services.
✓ 2025 Florida Statutes — current through the 2025 Regular Session
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627.638 Direct payment for hospital, medical services.—
(1) Any health insurance policy insuring against loss or expense due to hospital confinement or to medical and related services may provide for payment of benefits directly to any recognized hospital, licensed ambulance provider, doctor, or other person who provided the services, in accordance with the provisions of the policy. To comply with this section, the words “or to the hospital, licensed ambulance provider, doctor, or person rendering services covered by this policy,” or similar words appropriate to the terms of the policy, shall be added to applicable provisions of the policy.
(2) Whenever, in any health insurance claim form, an insured specifically authorizes payment of benefits directly to any recognized hospital, licensed ambulance provider, physician, dentist, or other person who provided the services in accordance with the provisions of the policy, the insurer shall make such payment to the designated provider of such services. The insurance contract may not prohibit, and claims forms must provide an option for, the payment of benefits directly to a licensed hospital, licensed ambulance provider, physician, dentist, or other person who provided the services in accordance with the provisions of the policy for care provided. The insurer may require written attestation of assignment of benefits. Payment to the provider from the insurer may not be more than the amount that the insurer would otherwise have paid without the assignment.
(3) Any insurer who has contracted with a preferred provider, as defined in s. 627.6471(1)(b), for the delivery of health care services to its insureds shall make payments directly to the preferred provider for such services.
History.—s. 581, ch. 59-205; s. 3, ch. 76-168; s. 1, ch. 77-457; ss. 2, 3, ch. 81-318; ss. 487, 497, 809(2nd), ch. 82-243; s. 79, ch. 82-386; s. 1, ch. 85-160; s. 114, ch. 92-318; s. 4, ch. 2005-231; s. 2, ch. 2008-212; ss. 1, 2, ch. 2009-124.
Notes of Decisions
Cited in 7
cases (3 in the last 5 years), 1991–2024 · leading case: Sec. First Ins. Co. v. State, Off. of Ins. Reg., 177 So. 3d 627 (Fla. 1st DCA 2015).
Sec. First Ins. Co. v. State, Off. of Ins. Reg., 177 So. 3d 627 (Fla. 1st DCA 2015). “2d at 1143 (citing § 627.638(2), Fla. Stat. (2005)). The Fourth District recognized that “[p]ublic policy may limit the parties’ freedom to incorporate an anti-assignment clause into a contract” but concluded that “public policy favors the type of anti-assignment clause at issue…”
Abraham K. Kohl, Dc v. Blue Cross, 955 So. 2d 1140 (Fla. 4th DCA 2007). “, the insurer shall make such payment to the designated provider of such services, unless otherwise provided in the insurance contract.”
Pennsylvania Blue Shield v. Wolfe, 575 So. 2d 1361 (Fla. 3d DCA 1991). “1985); § 627.638, Fla.Stat. (1989). With regard to the specific evidentiary objections of the insurer, we conclude that the assignment of benefits form was properly authenticated.”
Gvb Md, LLC v. Blue Cross & Blue Shield of Florida, Inc. (S.D. Fla. 2019). “3:18-cv-01510, 2019 WL 5104773 , at *5 (M.D. Fla. Sept. 19, 2019) (“ERISA-regulated plans control the payment of benefits, coverage determinations, obligation to pay for benefits, and whom may be paid directly by insurers.”
Beth Wolf, APRN-BC LLC v. CIGNA Health & Life Ins. Co. (S.D. Fla. 2024). “If healthcare providers were already entitled to payment as third-party beneficiaries under § 627.638, why would the very same statute require the provider to produce an assignment of benefits? This very germane question—which calls the Plaintiffs’ third-party beneficiary status…”
Epic Reference Labs, Inc. v. Cigna Health & Life Ins. Co. (D. Conn. 2021). “Fla. Stat. Ann. § 627.638 (2) (“Whenever, in any health insurance claim form, an insured specifically authorizes payment of benefits directly to any recognized [provider] in accordance with the provisions of the policy, the insurer shall make such payment to the designated…”
Connecticut Gen. Life Ins. Co. v. BioHealth Labs., Inc. (D. Conn. 2024). “Fla. Stat. § 627.638 (2) (emphasis added).”
— 627.638(2) — 3 cases
Sec. First Ins. Co. v. State, Off. of Ins. Reg., 177 So. 3d 627 (Fla. 1st DCA 2015). “2d at 1143 (citing § 627.638(2), Fla. Stat. (2005)). The Fourth District recognized that “[p]ublic policy may limit the parties’ freedom to incorporate an anti-assignment clause into a contract” but concluded that “public policy favors the type of anti-assignment clause at issue…”
Abraham K. Kohl, Dc v. Blue Cross, 955 So. 2d 1140 (Fla. 4th DCA 2007). “, the insurer shall make such payment to the designated provider of such services, unless otherwise provided in the insurance contract.”
Gvb Md, LLC v. Blue Cross & Blue Shield of Florida, Inc. (S.D. Fla. 2019). “3:18-cv-01510, 2019 WL 5104773 , at *5 (M.D. Fla. Sept. 19, 2019) (“ERISA-regulated plans control the payment of benefits, coverage determinations, obligation to pay for benefits, and whom may be paid directly by insurers.”
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