Health Insurance Online
Phone Icon
Call now to speak with a Licensed agent (866) 954-1892

Insurance Type:

Get Your Claim Paid: HMO Coverage Disputes Introduction

For years, doctors and hospitals have complained that health maintenance organizations fail to pay them in a timely manner. State insurance departments have collected such complaints on nearly every major HMO in the United States.

HMOs cite a series of reasons for the problem, including, but not limited to, their computers, the status of plan members, and doctors and hospitals that file incomplete or inaccurate claim forms.

In Florida, the state Agency for Health Care Administration and the Insurance Department met with the HMOs and health care providers to address the issue. As expected, they didn't agree on much. So, the doctors and hospitals went to the legislature for help. The result: a new law that would require HMOs to pay 10 percent interest per year for any claim that is not paid within 120 days. The rest of the law merely codifies existing state regulations.

The HMO lobby, which has shown the ability to kill or at least water down any bill it doesn't like, did not fight the proposal.

"The HMOs seem to control the process, especially in the Senate," said Scotty Frazier, a long-time lobbyist for the Florida Medical Association, which represents 16,000 doctors.

Google Plus One