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
FL HMO Appeal – Refund Recoupment
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 properly reimburse medically necessary services as required by state law. Our investigation has concluded the following: Please be advised that must meet the written requirements set forth in... View more
FL HMO Appeal – Retroactive Denial for Authorized 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 authorized health services as required by state law. On , authorization number was issued by . Please be advised 37 Fla. Stat. §641.3156 (1-2) states: (1) A health... View more
FL HMO Appeal – Untimely Payment
Last Updated: May 4, 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 timely reimburse this claim and 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),... View more
GA HMO Affidavit – Interest Owed on Late Claims
Last Updated: November 21, 2021 | Letter Type: Affidavits | Jurisdiction: GA HMO
AFFIDAVIT OF COMPLIANCE Interest Owed on Late Claims 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 GA Code §33-24-59.14(c), which states:... View more
GA HMO Affidavit – Maternity Coverage
Last Updated: October 15, 2021 | Letter Type: Affidavits | Jurisdiction: GA HMO
AFFIDAVIT OF COMPLIANCE Maternity 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 GA Code §33-24-58.2(b-c), which states: (b) Every... View more