STORAGE NAME: h0839b.HFS
DATE: 4/9/2025
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FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: CS/HB 839
TITLE: Insurance Overpayment Claims Submitted to
Psychologists
SPONSOR(S): Booth
COMPANION BILL: SB 2 (Rodriguez)
LINKED BILLS: None
RELATED BILLS: CS/SB 944 (Davis)
Committee References
Insurance & Banking
17 Y, 0 N, As CS
Health Care Facilities & Systems
Commerce
SUMMARY
Effect of the Bill:
By default, under Florida law, health insurers and health maintenance organizations (HMOs) have 30 months after
rendering payment to a provider to submit a claim for overpayment. The bill reduces the 30-month period to 12
months for overpayment claims submitted to licensed psychologists provided on or after January 1, 2026.
The bill adds licensed psychologists to a list of providers that already enjoy the shortened overpayment claim
window under Florida law. Existing law applies the 12-month period for overpayment claims to several licensed
providers (chiropractors, podiatrists, osteopaths, certain physicians and dental surgeons).
Fiscal or Economic Impact:
Insurers and HMOs may recover less from overpaid claims to psychologists due to the reduced overpayment claim
period. The effect on premiums is indeterminate.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Psychologist Overpayment Claims
The bill adds psychologists licensed under ch. 490, F.S., to a list of licensed providers that enjoy a reduced time
period for insurers and health maintenance organizations (HMOs) to submit claims for overpayment. Under the
reduced time period, claims for overpayment must be submitted to the provider within 12 months, rather than the
standard 30-month period.
The changes in the bill apply to claims for services provided on or after January 1, 2026.
FISCAL OR ECONOMIC IMPACT:
PRIVATE SECTOR:
Insurers may recover less from overpaid claims to psychologists due to the reduced overpayment claim period.
The effect on premiums is indeterminate.
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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RELEVANT INFORMATION
SUBJECT OVERVIEW:
Health Care Service Claims Overpayments
An overpayment is an insurance reimbursement for provider services in an amount that is more than is required
by the contract between the payer and the provider. Overpayments might take the following forms:
Duplicate Payments – Patients or their family members may inadvertently make multiple payments
for the same service.
1
Billing or Coding Errors – Mistakes in billing codes or modifiers can occur and lead to inaccurate
charges on a patient’s account.
2
Excess Patient Responsibility Collected – A patient’s insurance benefits or deductibles may be
miscalculated by either the patient or the health care practitioner.
3
Coordination of Benefits Between Multiple Insurers – Patients sometimes have two or more
sources of insurance coverage (primary and secondary insurance plans). If both insurers remit
payment and inadvertently exceed the cost of the service, the health care practitioner may receive
funds beyond what is contractually required.
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Oftentimes, overpayment claims are the result of a retroactive review or audit of coverage decisions and payment
levels.
Subsections s. 627.6131(6), F.S., and 641.3155(5), F.S., govern the process by which a health insurer or health
maintenance organization (HMO) may make a claim for overpayment against a provider to whom it rendered
payment. The insurer or HMO must send a written or electronic statement specifying the basis for the retroactive
denial or payment adjustment to the provider of the specific provider claim(s) for which the overpayment is
submitted.
If the overpayment is not related to fraud, the health insurer or HMO must submit its claim for overpayment within
30 months after the insurer or HMO paid the claim. After receiving the claim for overpayment, the provider has 40
days in which to pay, deny, or contest the claim. A contested claim for overpayment must be paid or denied by the
provider within 120 days after receipt. If, after 140 days, the provider has not paid or denied the overpayment
claim, an uncontestable obligation is placed on the provider to pay the insurer or HMO claim. A provider that
chooses to deny or contest an insurer or HMO claim must notify the insurer or HMO in writing of the provider’s
decision within 35 days after the provider received the claim for overpayment. If the claim is contested, the
provider must request additional information, which the insurer or HMO has 35 days to give the provider after
receiving the request. After receiving the additional information, the provider has 45 days to pay or deny the claim.
Subsections s. 627.6131(18), F.S., and s. 641.3155(16), F.S., establishes a different time period for overpayment
claims for certain providers. Claims for overpayment must be submitted within 12 months, rather than the usual
30-month period for physicians licensed under ch. 458, F.S., osteopaths licensed under ch. 459, F.S., chiropractors
licensed under ch. 460, F.S., podiatrists licensed under ch. 461, F.S., and (for oral surgery only) dental surgeons
licensed under ch. 466, F.S.
1 Azad, T. and William, P., Fraud Detection in Healthcare Billing and Claims, International Journal of Science and Research April 2025 (Vol 15,
Issue 1), available at https://ijsra.net/content/fraud-detection-healthcare-billing-and-claims (last visited, April 8, 2025).
2 Id.
3 PBS News, Health Insurance Claim Denials are on the Rise, to the Detriment of Patients, available at
https://www.pbs.org/newshour/health/analysis-health-insurance-claim-denials-are-on-the-rise-to-the-detriment-of-patients (last visited,
April 8, 2025).
4 Nupur Gambir, Coordination of Benefits: How Having Two Health Insurance Plans Works, (March 11, 2025) available at
https://www.insure.com/health-insurance/how-coordination-of-benefits-works/ (last visited, April 8, 2025). JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Insurance & Banking
Subcommittee
17 Y, 0 N, As CS Lloyd Schenk
THE CHANGES ADOPTED BY THE
COMMITTEE:
The amendment applied the same change to health maintenance organizations
(HMOs) as the original bill provided for health insurers.
Health Care Facilities & Systems
Subcommittee
Calamas Aderibigbe
Commerce Committee
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THIS BILL ANALYSIS HAS BEEN UPDATED TO INCORPORATE ALL OF THE CHANGES DESCRIBED ABOVE.
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