Fla. Stat. 627.6044
Use of a specific methodology for payment of claims

(1)

Each insurance policy that provides for payment of claims based on a specific methodology, including, but not limited to, usual and customary charges, reasonable and customary charges, or charges based upon the prevailing rate in the community, shall specify the formula or criteria used by the insurer in determining the amount to be paid.

(2)

Each insurer issuing a policy that provides for payment of claims based on a specific methodology shall provide to an insured, upon her or his written request, an estimate of the amount the insurer will pay for a particular medical procedure or service. The estimate may be in the form of a range of payments or an average payment. The insurer may require the insured to provide detailed information regarding the procedure or service to be performed, including the procedure or service code number provided by the health care provider and the health care provider’s estimated charge. An insurer that provides an insured with a good faith estimate is not bound by the estimate. However, a pattern of providing estimates that vary significantly from the ultimate insurance payment constitutes a violation of this code.

Source: Section 627.6044 — Use of a specific methodology for payment of claims, https://www.­flsenate.­gov/Laws/Statutes/2024/0627.­6044 (accessed Aug. 7, 2025).

627.601
Scope of this part 627.602
Scope, format of policy 627.603
Death benefits 627.604
Nonresident insured 627.605
Required provisions 627.606
Entire contract 627.607
Time limit on certain defenses 627.608
Grace period 627.609
Reinstatement 627.610
Notice of claim 627.611
Claim forms 627.612
Proof of loss 627.613
Time of payment of claims 627.614
Payment of claims 627.615
Physical examination, autopsy 627.616
Legal actions 627.617
Change of beneficiary 627.618
Optional policy provisions 627.619
Change of occupation 627.620
Misstatement of age or sex 627.621
Other insurance with this insurer 627.622
Insurance with other insurers 627.623
Insurance with other insurers 627.624
Relation of earnings to insurance 627.625
Unpaid premiums 627.627
Conformity with statutes 627.628
Illegal occupation 627.629
Intoxicants and narcotics 627.630
Order of certain provisions 627.631
Third-party ownership 627.632
Requirements of other jurisdictions 627.633
Other policy provisions 627.634
Age limit 627.635
Excess insurance 627.636
Industrial health insurance 627.637
Construction of noncomplying contracts 627.638
Direct payment for hospital, medical services 627.639
Application signed by agent 627.640
Filing of classifications and rates 627.641
Coverage for newborn children 627.642
Outline of coverage 627.643
Uniform minimum standards 627.644
Discrimination against handicapped prohibited 627.645
Denial of health insurance claims restricted 627.646
Conversion on termination of eligibility 627.647
Standard health claim form 627.6011
Mandated coverages 627.6041
Children with disabilities 627.6043
Notification of cancellation, nonrenewal, or change in rates 627.6044
Use of a specific methodology for payment of claims 627.6045
Preexisting condition 627.6046
Limit on preexisting conditions 627.6056
Coverage for ambulatory surgical center service 627.6131
Payment of claims 627.6141
Denial of claims 627.6265
Cancellation or nonrenewal prohibited 627.6385
Disclosures to policyholders 627.6387
Shared savings incentive program 627.6401
Refunds for persons age 64 627.6402
Insurance rebates for healthy lifestyles 627.6403
Payment of acupuncture benefits to certified acupuncturists 627.6405
Decreasing inappropriate utilization of emergency care 627.6406
Maternity care 627.6407
Massage 627.6408
Diabetes treatment services 627.6409
Coverage for osteoporosis screening, diagnosis, treatment, and management 627.6415
Coverage for natural-born, adopted, and foster children 627.6416
Coverage for child health supervision services 627.6417
Coverage for surgical procedures and devices incident to mastectomy 627.6418
Coverage for mammograms 627.6419
Requirements with respect to breast cancer 627.6425
Renewability of individual coverage 627.6426
Short-term health insurance 627.6471
Contracts for reduced rates of payment 627.6472
Exclusive provider organizations 627.6473
Combined preferred provider and exclusive provider policies 627.6474
Provider contracts 627.6475
Individual reinsurance pool 627.6487
Guaranteed availability of individual health insurance coverage to eligible individuals 627.64025
Advanced practice registered nurse services 627.64171
Coverage for length of stay and outpatient postsurgical care 627.64172
Requirements with respect to breast cancer and routine followup care 627.64193
Required coverage for cleft lip and cleft palate 627.64194
Coverage requirements for services provided by nonparticipating providers 627.64195
Requirements for opioid coverage 627.64196
Medication synchronization 627.64197
Coverage for organ transplants 627.64725
Health maintenance organization or exclusive provider organization 627.64731
Leasing, renting, or granting access to a participating provider 627.64741
Pharmacy benefit manager contracts 627.64995
Restrictions on use of state and federal funds for state exchanges

Current through Fall 2025

§ 627.6044. Use of a specific methodology for payment of claims's source at flsenate​.gov