FL HMO Affidavit – Poststabilization Timeframe
Last Updated: May 4, 2021 | Letter Type: Affidavits | Jurisdiction: FL HMO
AFFIDAVIT OF COMPLIANCE Poststabilization Care Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of 37 Fla.... View more
FL HMO Affidavit – Refund Recoupment
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: FL HMO
AFFIDAVIT OF COMPLIANCE Refund Recoupment Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of 37 Fla. Stat... View more
FL HMO Affidavit – Retroactive Denial for Authorized Care
Last Updated: November 20, 2021 | Letter Type: Affidavits | Jurisdiction: FL HMO
AFFIDAVIT OF COMPLIANCE Retroactive Denial of Authorized Services Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of... View more
FL HMO Affidavit – Untimely Payment
Last Updated: May 4, 2021 | Letter Type: Affidavits | Jurisdiction: FL HMO
AFFIDAVIT OF COMPLIANCE Prompt Payment to Providers Incorporated by Reference in 28 US Code § 1746 Patient/Multiple Patients: DOS: I hereby certify that I have collected, verified, and am maintaining on file evidence that the below Health Plan or Contracted Entity has met the provisions of 37... View more
FL HMO Appeal – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to remit automatic interest accrued on this claim as required by state law. Our investigation has concluded the following: Per 37 Fla. Stat. §627.613(2), must “…reimburse all claims or... View more
FL HMO Appeal – Maternity Coverage
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to provide coverage for maternity services and care as required by state law. Our investigation has concluded the following: As you may know, 37 §Fla. Stat. §641.19(6) states: (6)... View more
FL HMO Appeal – Medical Necessity – Qualified Reviewers
Last Updated: November 21, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that our treating physician was a . However, your reviewer... View more
FL HMO Appeal – No Authorization for ER Services and Care
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to reimburse emergency services as required by state law. Our investigation has concluded the following: 37 Fla. Stat. §641.47(8) defines “emergency services and care” as: (8) “Emergency services and care”... View more
FL HMO Appeal – Notice Requirements for Adverse Determinations
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to reimburse medically necessary services and care as required by state law. Our investigation has concluded the following: On , denied this claim as not medically necessary. To date,... View more
FL HMO Appeal – Poststabilization Timeframe
Last Updated: November 20, 2021 | Letter Type: Appeals | Jurisdiction: FL HMO
IMPERATIVE-ACTION REQUIRED Dear Director of : This office has been asked to file a formal complaint with the Florida Department of Financial Services for ’s failure to reimburse emergency and/or statutorily authorized post-stabilization services and care as required by state law. Our investigation has concluded the following: TO DATE, HAS FAILED TO REIMBURSE EMERGENCY AND... View more