Senate Bill sb0992c1

    Florida Senate - 2001                            CS for SB 992

    By the Committee on Banking and Insurance; and Senator Carlton





    311-1558-01

  1                      A bill to be entitled

  2         An act relating to dental service claim

  3         denials; amending s. 627.419, F.S.; providing

  4         for appeals from certain adverse

  5         determinations; providing an effective date.

  6

  7  Be It Enacted by the Legislature of the State of Florida:

  8

  9         Section 1.  Subsection (9) is added to section 627.419,

10  Florida Statutes, to read:

11         627.419  Construction of policies.--

12         (9)  With respect to any group or individual insurer

13  covering dental services, each claimant, or dentist acting for

14  a claimant, who has had a claim denied as not medically or

15  dentally necessary or who has had a claim payment based on an

16  alternate dental service in accordance with accepted dental

17  standards for adequate and appropriate care must be provided

18  an opportunity for an appeal to the insurer's licensed dentist

19  who is responsible for the medical necessity reviews under the

20  plan or is a member of the plan's peer review group. The

21  appeal may be by telephone, and the insurer's dentist must

22  respond within a reasonable time, not to exceed 15 business

23  days.

24         Section 2.  This act shall take effect July 1, 2001,

25  and shall apply to policies issued or renewed after that date.

26

27          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
28                              SB 992

29

30  Deletes the provision which required insurance companies
    offering dental coverage to ensure that only a licensed
31  dentist could render an adverse determination regarding a
    service provided by a dentist licensed in Florida.
                                  1

CODING: Words stricken are deletions; words underlined are additions.