Florida Senate - 2025                                    SB 1842
       
       
        
       By Senator Burton
       
       
       
       
       
       12-01057A-25                                          20251842__
    1                        A bill to be entitled                      
    2         An act relating to out-of-network providers; amending
    3         s. 456.0575, F.S.; requiring a health care
    4         practitioner to notify a patient in writing upon
    5         referring the patient to certain providers; providing
    6         requirements for such notice; providing for health
    7         care practitioner disciplinary action under certain
    8         conditions; amending s. 627.6471, F.S.; requiring
    9         certain health insurers to apply payments for services
   10         provided by nonpreferred providers toward insureds’
   11         deductibles and out-of-pocket maximums if specified
   12         conditions are met; providing an effective date.
   13          
   14  Be It Enacted by the Legislature of the State of Florida:
   15  
   16         Section 1. Present subsection (2) of section 456.0575,
   17  Florida Statutes, is redesignated as subsection (3), and a new
   18  subsection (2) is added to that section, to read:
   19         456.0575 Duty to notify patients.—
   20         (2) A health care practitioner shall notify a patient in
   21  writing upon referring the patient to a nonparticipating
   22  provider for nonemergency services, as those terms are defined
   23  in s. 627.64194(1), or to a provider, as defined in s. 641.47,
   24  that is not under contract with the patient’s health maintenance
   25  organization. Such notice must state that the services will be
   26  provided on an out-of-network basis, which may result in
   27  additional cost-sharing responsibilities for the patient, and
   28  such notice must be documented in the patient’s medical record.
   29  Failure to comply with this subsection, without good cause,
   30  shall result in disciplinary action against the health care
   31  practitioner.
   32         Section 2. Present subsection (7) of section 627.6471,
   33  Florida Statutes, is redesignated as subsection (8), and a new
   34  subsection (7) is added to that section, to read:
   35         627.6471 Contracts for reduced rates of payment;
   36  limitations; coinsurance and deductibles.—
   37         (7) Any insurer issuing a policy of health insurance in
   38  this state shall apply the payment for a service provided to an
   39  insured by a nonpreferred provider toward the insured’s
   40  deductible and out-of-pocket maximum as if the service had been
   41  provided by a preferred provider if all of the following
   42  conditions apply:
   43         (a) The insured requests that the insurer apply the payment
   44  for the service provided to the insured by the nonpreferred
   45  provider toward the insured’s deductible and out-of-pocket
   46  maximum.
   47         (b) The service provided to the insured by the nonpreferred
   48  provider is within the scope of services covered under the
   49  insured’s policy.
   50         (c) The amount that the nonpreferred provider charged the
   51  insured for the service is the same as or less than:
   52         1. The average amount that the insured’s preferred provider
   53  network charges for the service; or
   54         2. The statewide average amount for the service based on
   55  data reported on the Florida Health Finder website.
   56         Section 3. This act shall take effect July 1, 2025.