FL S1198

Expands Florida's statewide provider and health plan claim dispute resolution program to include denied prior authorization requests, making participation mandatory for all providers and health plans with no opt-out option

Defines "denied prior authorization request" to include wholly or partially disapproved requests, requests not acted upon within legal time limits, or approvals with materially restrictive conditions preventing services as clinically indicated

Requires health plans determined to be the nonprevailing party in disputes involving denied prior authorizations to reimburse providers for reasonable costs, including filing fees and administrative costs

Extends existing payment protections for dentists to physicians: health insurers and HMOs cannot require credit card as the only payment method, must obtain consent before using electronic funds transfers, and cannot charge fees for automated clearinghouse transfers without consent (effective January 1, 2027 for physicians)

Prohibits health insurers and HMOs from denying claims for procedures included in prior authorizations for physicians (in addition to existing protections for dentists), with limited exceptions such as benefit limitations, fraudulent claims, or changes in patient condition (effective January 1, 2027)