Florida Statute 641.3156 - Full Text and Legal Analysis

The 2025 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

Annotations, Discussions, Cases:

Cases Citing Statute 641.3156

Total Results: 3

Foundation Health v. WESTSIDE EKG ASSOC.

944 So. 2d 188

Supreme Court of Florida | Filed: Oct 19, 2006 | Docket: 1649903

Cited 23 times | Published

payment of fees to the provider." § 641.3154(1). Section 641.3156(1) requires HMOs to pay "any hospital-service

In Re Managed Care Litigation

135 F. Supp. 2d 1253, 2001 U.S. Dist. LEXIS 7776, 2001 WL 220108

District Court, S.D. Florida | Filed: Mar 2, 2001 | Docket: 2370418

Cited 11 times | Published

insurance costs or cost increases"); Fla. Stat. § 641.3156 (prohibiting arbitrary denial of claims), Tex

Joseph L. Riley Anesthesia Associates v. Stein

27 So. 3d 140, 2010 Fla. App. LEXIS 556, 2010 WL 322156

District Court of Appeal of Florida | Filed: Jan 29, 2010 | Docket: 1664799

Published

members pursuant to section 641.3156(1). When the trial court reviewed section 641.3156(1), it found that