Senate Bill 1526 (2025) — Health insurance claims
SB 1526
Florida Bills
Florida Senate - 2025 SB 1526 By Senator Harrell 31-01447-25 20251526__ Page 1 of 8 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to health insurance claims; amending 2 s. 627.6131, F.S.; prohibiting a contract between a 3 health insurer and a physician from containing certain 4 restrictions on payment methods; requiring a health 5 insurer to make certain notifications and obtain a 6 physician’s consent before paying a claim to the 7 physician through electronic funds transfer; providing 8 that the physician’s consent applies to the 9 physician’s entire practice; requiring the physician’s 10 consent to bear the signature of the physician; 11 prohibiting the physician from requiring consent on a 12 patient-by-patient basis; prohibiting a health insurer 13 from charging a fee to transmit a payment to a 14 physician through Automated Clearing House (ACH) 15 transfer unless the physician has consented to such 16 fee; revising applicability; providing applicability; 17 prohibiting a health insurer from denying a certain 18 claims submitted by a physician; amending s. 641.315, 19 F.S.; prohibiting a contract between a health 20 maintenance organization and a physician from 21 containing certain restrictions on payment methods; 22 requiring the health maintenance organization to make 23 certain notifications and obtain a physician’s consent 24 before paying a claim to the physician through 25 electronic funds transfer; providing that the 26 physician’s consent applies to the physician’s entire 27 practice; requiring the physician’s consent to bear 28 the signature of the physician; prohibiting the 29
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 2 of 8 CODING: Words stricken are deletions; words underlined are additions. physician from requiring consent on a patient-by-30 patient basis; prohibiting a health maintenance 31 organization from charging a fee to transmit a payment 32 to a physician through ACH transfer unless the 33 physician has consented to such fee; revising 34 applicability; providing applicability; prohibiting a 35 health maintenance organization from denying certain 36 claims submitted by a physician; providing an 37 effective date. 38 39 Be It Enacted by the Legislature of the State of Florida: 40 41
Section 1. Paragraphs (
a) through (
d) of subsection (20) 42 and paragraphs (
a) and (
b) of subsection (21) of
section 43 627.6131, Florida Statutes, are amended to read: 44 627.6131 Payment of claims.— 45 (20)(
a) A contract between a health insurer and a dentist 46 licensed under
chapter 466 or a physician licensed under
chapter 47 458 or
chapter 459 for the provision of services to an insured 48 may not specify credit card payment as the only acceptable 49 method for payments from the health insurer to the dentist or 50 physician. 51 (
b) When a health insurer employs the method of claims 52 payment to a dentist or physician through electronic funds 53 transfer, including, but not limited to, virtual credit card 54 payment, the health insurer shall notify the dentist or 55 physician as provided in this paragraph and obtain the dentist’s 56 or physician’s consent before employing the electronic funds 57 transfer. The dentist’s or physician’s consent described in this 58
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 3 of 8 CODING: Words stricken are deletions; words underlined are additions. paragraph applies to the dentist’s or physician’s entire 59 practice. For the purpose of this paragraph, the dentist’s or 60 physician’s consent, which may be given through e-mail, must 61 bear the signature of the dentist or physician. Such signature 62 includes an electronic or digital signature if the form of 63 signature is recognized as a valid signature under applicable 64 federal law or state contract law or
an act that demonstrates 65 express consent, including, but not limited to, checking a box 66 indicating consent. The insurer, physician, or dentist may not 67 require that a dentist’s or physician’s consent as described in 68 this paragraph be made on a patient-by-patient basis. The 69 notification provided by the health insurer to the dentist or 70 physician must include all of the following: 71 1. The fees, if any, associated with the electronic funds 72 transfer. 73 2. The available methods of payment of claims by the health 74 insurer, with clear instructions to the dentist or physician on 75 how to select an alternative payment method. 76 (
c) A health insurer that pays a claim to a dentist or 77 physician through automated clearinghouse transfer may not 78 charge a fee solely to transmit the payment to the dentist or 79 physician unless the dentist has consented to the fee. 80 (
d) For contracts entered into between an insurer and a 81 dentist, this subsection applies to contracts delivered, issued, 82 or renewed on or after January 1, 2025. For contracts entered 83 into between an insurer and a physician, this subsection applies 84 to contracts delivered, issued, or renewed on or after January 85 1, 2026. 86 (21)(
a) A health insurer may not deny any claim 87
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 4 of 8 CODING: Words stricken are deletions; words underlined are additions. subsequently submitted by a dentist licensed under
chapter 466 88 or a physician licensed under
chapter 458 or
chapter 459 for 89 procedures specifically included in a prior authorization unless 90 at least one of the following circumstances applies for each 91 procedure denied: 92 1. Benefit limitations, such as annual maximums and 93 frequency limitations not applicable at the time of the prior 94 authorization, are reached subsequent to issuance of the prior 95 authorization. 96 2. The documentation provided by the person submitting the 97 claim fails to support the claim as originally authorized. 98 3.
Subsequent to the issuance of the prior authorization, 99 new procedures are provided to the patient or a change in the 100 condition of the patient occurs such that the prior authorized 101 procedure would no longer be considered medically necessary, 102 based on the prevailing standard of care. 103 4.
Subsequent to the issuance of the prior authorization, 104 new procedures are provided to the patient or a change in the 105 patient’s condition occurs such that the prior authorized 106 procedure would at that time have required disapproval pursuant 107 to the terms and conditions for coverage under the patient’s 108 plan in effect at the time the prior authorization was issued. 109 5. The denial of the claim was due to one of the following: 110 a. Another payor is responsible for payment. 111 b. The dentist or physician has already been paid for the 112 procedures identified in the claim. 113 c.
The claim was submitted fraudulently, or the prior 114 authorization was based in whole or material part on erroneous 115 information provided to the health insurer by the dentist, 116
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 5 of 8 CODING: Words stricken are deletions; words underlined are additions. physician, patient, or other person not related to the insurer. 117 d. The person receiving the procedure was not eligible to 118 receive the procedure on the date of service. 119 e. The services were provided during the grace period 120 established under s. 627.608 or applicable federal regulations, 121 and the dental insurer notified the provider that the patient 122 was in the grace period when the dentist or physician provider 123 requested eligibility or enrollment verification from the dental 124 insurer, if such request was made. 125 (
b) For contracts entered into between an insurer and a 126 dentist, this subsection applies to all contracts delivered, 127 issued, or renewed on or after January 1, 2025. For contracts 128 entered into between an insurer and a physician, this subsection 129 applies to contracts delivered, issued, or renewed on or after 130 January 1, 2026. 131
Section 2. Paragraphs (
a) through (
d) of subsection (13) 132 and paragraphs (
a) and (
b) of subsection (14) of
section 133 641.315, Florida Statutes, are amended to read: 134 641.315 Provider contracts.— 135 (13)(
a) A contract between a health maintenance 136 organization and a dentist licensed under
chapter 466 or a 137 physician licensed under
chapter 458 or
chapter 459 for the 138 provision of services to a subscriber of the health maintenance 139 organization may not specify credit card payment as the only 140 acceptable method for payments from the health maintenance 141 organization to the dentist or physician. 142 (
b) When a health maintenance organization employs the 143 method of claims payment to a dentist or physician through 144 electronic funds transfer, including, but not limited to, 145
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 6 of 8 CODING: Words stricken are deletions; words underlined are additions. virtual credit card payment, the health maintenance organization 146 shall notify the dentist or physician as provided in this 147 paragraph and obtain the dentist’s or physician’s consent before 148 employing the electronic funds transfer. The dentist’s or 149 physician’s consent described in this paragraph applies to the 150 dentist’s or physician’s entire practice.
For the purpose of 151 this paragraph, the dentist’s or physician’s consent, which may 152 be given through e-mail, must bear the signature of the dentist 153 or physician. Such signature includes an electronic or digital 154 signature if the form of signature is recognized as a valid 155 signature under applicable federal law or state contract law or 156
an act that demonstrates express consent, including, but not 157 limited to, checking a box indicating consent. The health 158 maintenance organization or dentist or physician may not require 159 that a dentist’s or physician’s consent as described in this 160 paragraph be made on a patient-by-patient basis. The 161 notification provided by the health maintenance organization to 162 the dentist or physician must include all of the following: 163 1. The fees, if any, that are associated with the 164 electronic funds transfer. 165 2.
The available methods of payment of claims by the health 166 maintenance organization, with clear instructions to the dentist 167 on how to select an alternative payment method. 168 (
c) A health maintenance organization that pays a claim to 169 a dentist or physician through Automated Clearing House transfer 170 may not charge a fee solely to transmit the payment to the 171 dentist or physician unless the dentist or physician has 172 consented to the fee. 173 (
d) For contracts entered into between an insurer and a 174
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 7 of 8 CODING: Words stricken are deletions; words underlined are additions. dentist, this subsection applies to contracts delivered, issued, 175 or renewed on or after January 1, 2025. For contracts entered 176 into between an insurer and a physician, this subsection applies 177 to contracts delivered, issued, or renewed on or after January 178 1, 2026. 179 (14)(
a) A health maintenance organization may not deny any 180 claim subsequently submitted by a dentist licensed under
chapter 181 466 or a physician licensed under
chapter 458 or
chapter 459 for 182 procedures specifically included in a prior authorization unless 183 at least one of the following circumstances applies for each 184 procedure denied: 185 1. Benefit limitations, such as annual maximums and 186 frequency limitations not applicable at the time of the prior 187 authorization, are reached subsequent to issuance of the prior 188 authorization. 189 2. The documentation provided by the person submitting the 190 claim fails to support the claim as originally authorized. 191 3.
Subsequent to the issuance of the prior authorization, 192 new procedures are provided to the patient or a change in the 193 condition of the patient occurs such that the prior authorized 194 procedure would no longer be considered medically necessary, 195 based on the prevailing standard of care. 196 4.
Subsequent to the issuance of the prior authorization, 197 new procedures are provided to the patient or a change in the 198 patient’s condition occurs such that the prior authorized 199 procedure would at that time have required disapproval pursuant 200 to the terms and conditions for coverage under the patient’s 201 plan in effect at the time the prior authorization was issued. 202 5. The denial of the claim was due to one of the following: 203
Florida Senate - 2025 SB 1526 31-01447-25 20251526__ Page 8 of 8 CODING: Words stricken are deletions; words underlined are additions. a. Another payor is responsible for payment. 204 b. The dentist or physician has already been paid for the 205 procedures identified in the claim. 206 c. The claim was submitted fraudulently, or the prior 207 authorization was based in whole or material part on erroneous 208 information provided to the health maintenance organization by 209 the dentist, physician, patient, or other person not related to 210 the organization. 211 d.
The person receiving the procedure was not eligible to 212 receive the procedure on the date of service. 213 e. The services were provided during the grace period 214 established under s. 627.608 or applicable federal regulations, 215 and the dental insurer notified the dentist or physician 216 provider that the patient was in the grace period when the 217 provider requested eligibility or enrollment verification from 218 the dental insurer, if such request was made. 219 (
b) For contracts entered into between an insurer and a 220 dentist, this subsection applies to all contracts delivered, 221 issued, or renewed on or after January 1, 2025. For contracts 222 entered into between an insurer and a physician, this subsection 223 applies to contracts delivered, issued, or renewed on or after 224 January 1, 2026. 225