Obtaining Payment When an HMO Authorizes the Service

The FMA has received several phone calls recently from members who have run into the same problem: A patient comes into the office and the physician's front desk verifies insurance coverage with the patient's managed care organization. The managed care company later refuses to pay for the visit, stating that the patient was not covered under the plan at the time of service. The FMA worked hard during the 2000 legislative session to pass legislation to address this issue. Section 641.3156, Florida Statutes provides that if the HMO authorizes the service, then the HMO must pay the claim. For a copy of the applicable statute, click here. If you are an FMA member and have a question about this law, you can contact fplendl@medone.org.