Florida prompt pay law dental

Sourced answer

Under Fla. Stat. §627.6131; §641.3155; §627.613; §636.003(5), §636.004, §636.029(1), §636.035(15), the Florida payment deadline is 20 days to pay, deny, or contest (electronic) and 40 days to pay, deny, or contest (paper). Overdue payments bear simple interest at 12% per year, beginning when the claim should have been paid, denied, or contested, and the interest must be paid with the claim (§627.6131(7); identical for HMOs at §641.3155(6)). The section cannot be waived by contract. Dental applicability: Three lanes. (1) A dental plan is expressly inside §627.6131 where it pays the dentist directly — subsection (15) applies the section to "a group or individual insurance contract that only provides direct payments to dentists for enumerated dental services." Read that limb as written: a dental plan that reimburses the member rather than paying the dentist arguably sits outside it, and this record does not state the outer edge of §627.6131, because the "major medical expense" definition subsection (15) cross-references is a rulemaking category label rather than a definition (§627.643(2)(e)) and its content sits in Commission rule. (2) Comprehensive HMOs with dental benefits answer to the mirror rule at §641.3155 — §641.19(4) names dental care among comprehensive health care services, and §641.19(12) means a dental-only entity cannot be an HMO. (3) Prepaid dental plans licensed under Chapter 636 (prepaid limited health service organizations) have no statutory prompt-pay deadline and no interest rule at all — §636.004 and §636.029(1) exempt them from the Insurance Code unless specifically referenced, and neither §627.6131 nor §641.3155 mentions them. That is the lane a great many Florida dental practices actually bill, so never publish "Florida = 20/40 days, 12%" flat. A self-funded private-employer (ERISA) plan is generally beyond this statute's reach and runs on the federal claims-procedure clock instead — but that comes from the courts reading 29 U.S.C. § 1144, not from its text, and it is not categorical: a self-funded governmental or church plan is not an ERISA plan at all, § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law, and nothing in § 1144 bars a state from reaching the third-party administrator or the network contract.