Florida Statute 641.3156 | Lawyer Caselaw & Research

The 2024 Florida Statutes

Title XXXVII
INSURANCE

Chapter 641
HEALTH CARE SERVICE PROGRAMS

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F.S. 641.3156

641.3156 Treatment authorization; payment of claims.—

(1) A health maintenance organization must pay any hospital-service or referral-service claim for treatment for an eligible subscriber which was authorized by a provider empowered by contract with the health maintenance organization to authorize or direct the patient’s utilization of health care services and which was also authorized in accordance with the health maintenance organization’s current and communicated procedures, unless the provider provided information to the health maintenance organization with the willful intention to misinform the health maintenance organization.

(2) A claim for treatment may not be denied if a provider follows the health maintenance organization’s authorization procedures and receives authorization for a covered service for an eligible subscriber, unless the provider provided information to the health maintenance organization with the willful intention to misinform the health maintenance organization.

(3) Emergency services are subject to the provisions of s. 641.513 and are not subject to the provisions of this section.

History.—s. 4, ch. 2000-252.

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Amendments to 641.3156

Arrestable Offenses / Crimes under Fla. Stat. 641.3156

Level: Degree
Misdemeanor/Felony: First/Second/Third

Current data shows no reason an arrest or criminal charge should have occurred directly under Florida Statute 641.3156.

Annotations, Discussions, Cases:

Cases Citing Statute 641.3156

Total Results: 2

Joseph L. Riley Anesthesia Associates v. Stein

Court: Fla. Dist. Ct. App. | Date Filed: 2010-01-29T00:00:00-08:00

Citation: 27 So. 3d 140

Snippet: pursuant to section 641.3156(1). When the trial court reviewed section 641.3156(1), it found that under…governed not by section 641.3154(4), but by section 641.3156(1). That statute provides: (1) A health maintenance…the health maintenance organization, and section 641.3156 required Florida Health Care to pay whatever bill

Foundation Health v. WESTSIDE EKG ASSOC.

Court: Fla. | Date Filed: 2006-10-19T00:00:00-07:00

Citation: 944 So. 2d 188

Snippet: to the provider." § 641.3154(1). Section 641.3156(1) requires HMOs to pay "any hospital-service…willful intention to misinform the [HMO]." § 641.3156(2). The details set forth in the "prompt