[Avera Law Firm] Florida Supreme Court speaks on Prompt Pay....
1 view
Skip to first unread message
Mark Avera
Oct 22, 2006, 9:12:57 AM10/22/06
to avera-l...@googlegroups.com
Many of you will remember our comment in late September that dealt with the time periods in which health insurers had to pay medical bills incurred by you or your family.
In the past, health insurance entities took the position that these statutes, requiring payment within a certain time period, did not create a cause of action. In other words, even though the statutes set forth the time periods in which the company was supposed to pay, nowhere in the statute did it say that if the health insurer failed to comply with the statute, that a lawsuit could be filed by the patient or her health care provider.
This past Thursday, the Florida Supreme Court laid that question to rest. In Foundation Health v. Westside EKG, the Supreme Court ruled that a medical service provider (your doctor, the hospital, etc) could file a lawsuit against the HMO for its violation of its contract with you and violation of the prompt pay statutes. Remember, the prompt pay statutes set forth the time period in which a health insurance entity have to pay your medical bills, deny them, or investigate them. Check our blog on 9/26 for the specifics of the statute.
Foundation Health dealt with the HMO scenario. In my opinion, this opinion tells all lawyers in the health care field of what the Supreme Court would say with respect to prompt pay statutes that apply to health insurers that are not HMO's.
This opinion is good news for patients, and good news for the medical providers that care for them. At the same time, there is in place a process for a health insurer to investigate claims.
If you or your physician have a hard time getting the bills paid by your health insurer, keep in mind the prompt pay statutes.
--
Posted by Mark Avera to Avera Law Firm at 10/22/2006 08:58:00 AM
In the past, health insurance entities took the position that these statutes, requiring payment within a certain time period, did not create a cause of action. In other words, even though the statutes set forth the time periods in which the company was supposed to pay, nowhere in the statute did it say that if the health insurer failed to comply with the statute, that a lawsuit could be filed by the patient or her health care provider.
This past Thursday, the Florida Supreme Court laid that question to rest. In Foundation Health v. Westside EKG, the Supreme Court ruled that a medical service provider (your doctor, the hospital, etc) could file a lawsuit against the HMO for its violation of its contract with you and violation of the prompt pay statutes. Remember, the prompt pay statutes set forth the time period in which a health insurance entity have to pay your medical bills, deny them, or investigate them. Check our blog on 9/26 for the specifics of the statute.
Foundation Health dealt with the HMO scenario. In my opinion, this opinion tells all lawyers in the health care field of what the Supreme Court would say with respect to prompt pay statutes that apply to health insurers that are not HMO's.
This opinion is good news for patients, and good news for the medical providers that care for them. At the same time, there is in place a process for a health insurer to investigate claims.
If you or your physician have a hard time getting the bills paid by your health insurer, keep in mind the prompt pay statutes.
--
Posted by Mark Avera to Avera Law Firm at 10/22/2006 08:58:00 AM
Reply all
Reply to author
Forward
0 new messages