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Senate Targets Insurance Claim Denials

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The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Health insurers and health-maintenance organizations would be banned from retroactively denying claims if they verified eligibility at the time of treatment and provided authorization numbers, under a bill that moved forward Thursday in the Florida Senate.

Currently, a health insurer or HMO may retroactively deny a claim up to one year after payment. Medicaid HMOs would be exempt from the provisions of the Senate bill (SB 162), but the state group health-insurance plan would not be exempt.

A staff analysis indicates the requirements could result in a $166,347 hit to the state group plan. The Senate took up the bill Thursday and readied it for a vote as soon as next week. The House version (HB 217) is in the Appropriations Committee.