HB 1101 , Engrossed 1 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to out -of-network providers; amending 2
s. 456.0575, F.S.; requiring a health care 3
practitioner to notify a patient in writing upon 4
referring the patient to certain providers; providing 5
requirements for such notice; providing requirements 6
for a practitioner to confirm network status; 7
providing for health care practitioner disciplinary 8
action under certain conditions; amending s. 627.6471, 9
F.S.; requiring certain health insurers to apply 10
payments for services provided by nonpreferred 11
providers toward insureds' deductibles and out -of-12
pocket maximums if specified conditions are met; 13
providing an effective date. 14
15
Be It Enacted by the Legislature of t he State of Florida: 16
17
Section 1. Subsection (2) of section 456.0575, Florida 18
Statutes, is renumbered as subsection (3), and a new subsection 19
(2) is added to that section to read: 20
456.0575 Duty to notify patients. — 21
(2) A health care practitioner sha ll notify a patient in 22
writing upon referring the patient to a nonparticipating 23
provider for nonemergency services, as those terms are defined 24
in s. 627.64194(1), or to a provider, as defined in s. 641.47, 25
HB 1101 , Engrossed 1 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
that is not under contract with the patient's heal th maintenance 26
organization. Such notice must state that the services will be 27
provided on an out-of-network basis, which may result in 28
additional cost-sharing responsibilities for the patient, and 29
such notice must be documented in the patient's medical rec ord. 30
The practitioner or his or her employee may confirm the referral 31
provider's participation by contacting the referral provider or 32
the patient's health insurer or health maintenance organization, 33
as necessary, or may rely on the online provider director y of 34
the health insurer or health maintenance organization. Failure 35
to comply with this subsection, without good cause, shall result 36
in disciplinary action against the health care practitioner. 37
Section 2. Subsection (7) of section 627.6471, Florida 38
Statutes, is renumbered as subsection (8), and a new subsection 39
(7) is added to that section to read: 40
627.6471 Contracts for reduced rates of payment; 41
limitations; coinsurance and deductibles. — 42
(7) Any insurer issuing a policy of health insurance in 43
this state shall apply the payment for a service provided to an 44
insured by a nonpreferred provider toward the insured's 45
deductible and out-of-pocket maximum as if the service had been 46
provided by a preferred provider if all of the following apply: 47
(a) The insured requests that the insurer apply the 48
payment for the service provided to the insured by the 49
nonpreferred provider toward the insured's deductible and out -50
HB 1101 , Engrossed 1 2025
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
of-pocket maximum. 51
(b) The service provided to the insured by the 52
nonpreferred provider is withi n the scope of services covered 53
under the insured's policy. 54
(c) The amount that the nonpreferred provider charged the 55
insured for the service is the same as or less than: 56
1. The average amount that the insured's preferred 57
provider network charges for t he service; or 58
2. The statewide average amount for the service based on 59
data reported on the Florida Health Price Finder website. 60
Section 3. This act shall take effect July 1, 2025. 61