Avera Law Firm

The Avera Law Firm Blog is designed to update clients, vendors, and other interested persons regarding law firm news, personnel, legal issues, and legislative issues. The firm management welcomes posts and questions to the blog as an interactive means to provide information to the public.

Tuesday, September 26, 2006

Did You Know.....? Health Insurance and Paying Claims

Ever wonder when your health insurance company was going to pay for the bills you incurred for medical care or treatment?

Here at Avera & Avera, we frequently assist people with health insurance bills that the insurer is either denying payment on or is not paying timely; much to the concern of the patient and their health care provider.

Florida Statutes do provide time limitations within which a health insurance company must pay claims or notify you of their intent to contest or investigate the claims. Here are excerpts from Florida Statute 627.613 which is entitled "Time for Payment of Claims".....

(2) Health insurers shall reimburse all claims or any portion of any claim from an insured or an insured's assignees, for payment under a health insurance policy, within 45 days after receipt of the claim by the health insurer. If a claim or a portion of a claim is contested by the health insurer, the insured or the insured's assignees shall be notified, in writing, that the claim is contested or denied, within 45 days after receipt of the claim by the health insurer. The notice that a claim is contested shall identify the contested portion of the claim and the reasons for contesting the claim.

(3) A health insurer, upon receipt of the additional information requested from the insured or the insured's assignees shall pay or deny the contested claim or portion of the contested claim, within 60 days.

(4) An insurer shall pay or deny any claim no later than 120 days after receiving the claim.

(5) Payment shall be treated as being made on the date a draft or other valid instrument which is equivalent to payment was placed in the United States mail in a properly addressed, postpaid envelope or, if not so posted, on the date of delivery.

(6) All overdue payments shall bear simple interest at the rate of 10 percent per year.

(7) Upon written notification by an insured, an insurer shall investigate any claim of improper billing by a physician, hospital, or other health care provider. The insurer shall determine if the insured was properly billed for only those procedures and services that the insured actually received. If the insurer determines that the insured has been improperly billed, the insurer shall notify the insured and the provider of its findings and shall reduce the amount of payment to the provider by the amount determined to be improperly billed. If a reduction is made due to such notification by the insured, the insurer shall pay to the insured 20 percent of the amount of the reduction up to $500.

posted by Mark Avera at 9/26/2006 05:03:00 PM

0 Comments:

Post a Comment

<< Home