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The Florida Statutes
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The 1995 Florida Statutes
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627.6044 Use of a specific
methodology for payment of claims. ---
(1) Each insurance policy that provides for payment of
claims based on a specific methodology, including, but not limited
to, usual and customary charges, reasonable and customary charges,
or charges based upon the prevailing rate in the community, shall
specify the formula or criteria used by the insurer in determining
the amount to be paid.
(2) Each insurer issuing a policy that provides for
payment of claims based on a specific methodology shall provide to
an insured, upon his written request, an estimate of the amount the
insurer will pay for a particular medical procedure or service.
The estimate may be in the form of a range of payments or an
average payment. The insurer may require the insured to provide
detailed information regarding the procedure or service to be
performed, including the procedure or service code number provided
by the health care provider and the health care provider's
estimated charge. An insurer that provides an insured with a good
faith estimate is not bound by the estimate. However, a pattern of
providing estimates that vary significantly from the ultimate
insurance payment constitutes a violation of this
code.
History: ss. 9, 12, ch. 91-296; ss. 55, 114, ch. 92-318.
Note. Former s. 627.6145.
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