627.668 Optional coverage for mental and nervous disorders required; exception.—
(1) Every insurer, health maintenance organization, and nonprofit hospital and medical service plan corporation transacting group health insurance or providing prepaid health care in this state shall make available to the policyholder as part of the application, for an appropriate additional premium under a group hospital and medical expense-incurred insurance policy, under a group prepaid health care contract, and under a group hospital and medical service plan contract, the benefits or level of benefits specified in subsection (2) for the necessary care and treatment of mental and nervous disorders, as defined in the standard nomenclature of the American Psychiatric Association, subject to the right of the applicant for a group policy or contract to select any alternative benefits or level of benefits as may be offered by the insurer, health maintenance organization, or service plan corporation provided that, if alternate inpatient, outpatient, or partial hospitalization benefits are selected, such benefits shall not be less than the level of benefits required under paragraph (2)(a), paragraph (2)(b), or paragraph (2)(c), respectively.
(2) Under group policies or contracts, inpatient hospital benefits, partial hospitalization benefits, and outpatient benefits consisting of durational limits, dollar amounts, deductibles, and coinsurance factors shall not be less favorable than for physical illness generally, except that:
(a) Inpatient benefits may be limited to not less than 30 days per benefit year as defined in the policy or contract. If inpatient hospital benefits are provided beyond 30 days per benefit year, the durational limits, dollar amounts, and coinsurance factors thereto need not be the same as applicable to physical illness generally.
(b) Outpatient benefits may be limited to $1,000 for consultations with a licensed physician, a psychologist licensed pursuant to chapter 490, a mental health counselor licensed pursuant to chapter 491, a marriage and family therapist licensed pursuant to chapter 491, and a clinical social worker licensed pursuant to chapter 491. If benefits are provided beyond the $1,000 per benefit year, the durational limits, dollar amounts, and coinsurance factors thereof need not be the same as applicable to physical illness generally.
(c) Partial hospitalization benefits shall be provided under the direction of a licensed physician. For purposes of this part, the term “partial hospitalization services” is defined as those services offered by a program that is accredited by an accrediting organization whose standards incorporate comparable regulations required by this state. Alcohol rehabilitation programs accredited by an accrediting organization whose standards incorporate comparable regulations required by this state or approved by the state and licensed drug abuse rehabilitation programs shall also be qualified providers under this section. In a given benefit year, if partial hospitalization services or a combination of inpatient and partial hospitalization are used, the total benefits paid for all such services may not exceed the cost of 30 days after inpatient hospitalization for psychiatric services, including physician fees, which prevail in the community in which the partial hospitalization services are rendered. If partial hospitalization services benefits are provided beyond the limits set forth in this paragraph, the durational limits, dollar amounts, and coinsurance factors thereof need not be the same as those applicable to physical illness generally.
(3) Insurers must maintain strict confidentiality regarding psychiatric and psychotherapeutic records submitted to an insurer for the purpose of reviewing a claim for benefits payable under this section. These records submitted to an insurer are subject to the limitations of s. 456.057, relating to the furnishing of patient records.
...[5] DSM-III-R defines mental disorders apart from their original cause or any associated physical or chemical manifestations. Defendants maintain that this comports with the Florida Legislature's definition of mental and nervous disorders set forth in Fla. Stat. Section 627.668. [6] Plaintiff responds by arguing that DSM-III-R is merely used by the medical profession for purposes of classifying patients for treatment. Upon careful review of the above, this Court finds that Section 627.668 does not specifically refer to DSM-III-R in its language, nor does this Court find that it should be used for purposes of classifying Bipolar Affective Disorder as a mental or physical disorder....
...52, 58-63; Deposition of Robert Cullen, M.D., taken August 2, 1989, at pp. 8-9. [4] Deposition of Dr. McKnew, at pp. 63-65; Deposition of Dr. Pagan, at pp. 13-15. [5] Defendant's Exhibit "E" to Motion for Summary Judgment, at page 205; Defendant's Exhibit "F" to Motion for Summary Judgment, at page 225. [6] Fla.Stat. Section 627.668, provides in pertinent part: Optional coverage for mental and nervous disorders required; exception. (1) Every insurer, ..., transacting group health insurance in this state shall make available to the policyholder as part of the application, ..., the benefits ......
Published | District Court, M.D. Florida | 2004 WL 180428
...It is undisputed that The Renfrew Center is not licensed by the State of Florida as a hospital and will not qualify on that basis. Plaintiff concedes that The Renfrew Center is "not a traditional hospital." Doc. No. 38. Instead, Plaintiff contends that Florida Statute § 627.668 requires Defendants to provide "necessary" mental health benefits, including in-patient benefits, and in this case, treatment at The Renfrew Center. Section 627.668 states in pertinent part: (1) Every insurer ......
...and nervous disorders, as defined in the standard nomenclature of the American Psychiatric Association. * * * * * * (2) (a) Inpatient benefits may be limited to not less than 30 days per benefit year as defined in the policy or contract. Fla. Stat. § 627.668. Plaintiff argues that because the health care professionals who have treated Kathleen O'Reardon agreed that inpatient treatment was necessary to treat Kathleen's eating disorders, Defendants are required, under § 627.668, to reimburse Plaintiff for care at The Renfrew Center....
...construed against the Defendants. Defendants respond that, even if the treatment at The Renfrew Center was appropriate for Kathleen, it still is not covered because it was provided at a facility that is not covered under the Policy. They argue that § 627.668 merely requires Principal to offer its insureds a certain minimum level of benefits for mental and nervous disorders (no less than 30 days for inpatient treatment) and the Policy does provide for this level of benefits as long as they are provided at a covered facility....
...Since Plaintiff decided to obtain treatment for his daughter at a facility that was not covered under the Policy, rather than at a hospital that was covered, he cannot seek benefits that simply are not payable under the Policy. The Court finds Defendants' argument persuasive. Section 627.668 requires the insurer to provide a minimum of at least 30 days coverage for inpatient treatment of mental and nervous disorders, but does not mandate where. The Policy does provide coverage for 30 days of inpatient services for mental health or behavioral treatment services. Doc. No. 1, Ex. B at GC 5014 at 4. Plaintiff's interpretation of § 627.668 would require the insurer to provide treatment at any facility of Plaintiff's choosing, as long as a medical professional found treatment of the patient's condition to be "necessary." Plaintiff's own experts do not opine the treatment "nec...
This Florida statute resource is curated by Graham W. Syfert, Esq., a Jacksonville, Florida personal injury and workers' compensation attorney. Attorney Syfert regularly works with Chapter 627 in the context of insurance coverage law and represents clients throughout Northeast Florida. For legal consultation, call 904-383-7448.
