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The Committee on Commerce (Oelrich) recommended the following

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amendment:

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     Senate Amendment (with title amendment)

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     Between line(s) 211 and 212,

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insert:

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     Section 7.  Subsection (6) of section 627.6131, Florida

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Statutes, is amended to read:

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     627.6131  Payment of claims.--

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     (6)  If a health insurer determines that it has made an

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overpayment to a provider for services rendered to an insured,

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the health insurer must make a claim for such overpayment to the

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provider's designated location. A health insurer that makes a

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claim for overpayment to a provider under this section shall

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give the provider a written or electronic statement specifying

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the basis for the retroactive denial or payment adjustment. The

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insurer must identify the claim or claims, or overpayment claim

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portion thereof, for which a claim for overpayment is submitted.

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     (a)  If an overpayment determination is the result of

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retroactive review or audit of coverage decisions or payment

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levels not related to fraud, a health insurer shall adhere to

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the following procedures:

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     1.  All claims for overpayment must be submitted to a

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provider within 12 30 months after the health insurer's payment

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of the claim. A provider must pay, deny, or contest the health

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insurer's claim for overpayment within 40 days after the receipt

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of the claim. All contested claims for overpayment must be paid

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or denied within 120 days after receipt of the claim. Failure to

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pay or deny overpayment and claim within 140 days after receipt

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creates an uncontestable obligation to pay the claim.

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     2.  A provider that denies or contests a health insurer's

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claim for overpayment or any portion of a claim shall notify the

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health insurer, in writing, within 35 days after the provider

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receives the claim that the claim for overpayment is contested

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or denied. The notice that the claim for overpayment is denied

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or contested must identify the contested portion of the claim

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and the specific reason for contesting or denying the claim and,

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if contested, must include a request for additional information.

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If the health insurer submits additional information, the health

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insurer must, within 35 days after receipt of the request, mail

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or electronically transfer the information to the provider. The

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provider shall pay or deny the claim for overpayment within 45

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days after receipt of the information. The notice is considered

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made on the date the notice is mailed or electronically

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transferred by the provider.

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     3.  The health insurer may not reduce payment to the

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provider for other services unless the provider agrees to the

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reduction in writing or fails to respond to the health insurer's

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overpayment claim as required by this paragraph.

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     4.  Payment of an overpayment claim is considered made on

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the date the payment was mailed or electronically transferred.

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An overdue payment of a claim bears simple interest at the rate

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of 12 percent per year. Interest on an overdue payment for a

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claim for an overpayment begins to accrue when the claim should

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have been paid, denied, or contested.

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     (b)  A claim for overpayment shall not be permitted beyond

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12 30 months after the health insurer's payment of a claim,

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except that claims for overpayment may be sought beyond that

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time from providers convicted of fraud pursuant to s. 817.234.

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     Section 8.  Subsection (7) is added to section 627.6471,

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Florida Statutes, to read:

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     627.6471  Contracts for reduced rates of payment;

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limitations; coinsurance and deductibles.--

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     (7) For care other than for ambulance transport or

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treatment pursuant to part III of chapter 401 or services

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provided pursuant to s. 395.1041, a nonpreferred provider

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providing services to an insured under this section shall, upon

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request by the insured, provide the insured with an estimated

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range of charges for the services requested and a statement

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notifying the insured that the final charge may exceed the

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reimbursable amount under the insured's policy. There is no

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liability on the part of the nonpreferred provider if the final

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charge exceeds the initial estimate.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     On line(s) 29, after the first semicolon,

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insert:

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amending s. 627.6131, F.S.; reducing the period for a

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health insurer to submit a claim to a provider for

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overpayment; amending s. 627.6471, F.S.; requiring that a

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nonpreferred provider, upon request of the insured,

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provide to the insured the estimated range of charges for

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the services requested; specifying that the provider in

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not liable if the final charge exceeds the initial

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estimate;

3/10/2008  8:27:00 AM     577-04613A-08