Each claimant, or provider acting for a claimant, who has had a claim denied as not medically necessary must be provided an opportunity for an appeal to the insurer’s licensed physician who is responsible for the medical necessity reviews under the plan or is a member of the plan’s peer review group. The appeal may be by telephone, and the insurer’s licensed physician must respond within a reasonable time, not to exceed 15 business days.
Fla. Stat. § 627.6141
Denial of claims
Known as the Alonzo Mourning Access to Care Act
The act spans §§ 627.011 to 627.9913 (628 sections).
History.--s. 7, ch. 96-223.
Official source: Online Sunshine (Florida Legislature). Reproduced from public-domain Florida statutes; confirm against the official source for the current text. Not legal advice.