What is the difference between referral and authorization

Florida Health Care Plans does not reward staff for making denials, and does not use financial incentives that reward underutilization.

New information or technology that would be relevant to FHCP to consider when these policies are next reviewed may be submitted to:. Please have your patient refer to the applicable endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine coverage. Request for Review New information or technology that would be relevant to FHCP to consider when these policies are next reviewed may be submitted to: Florida Health Care Plans Clinical Services Division Ridgewood Avenue Holly Hill, Florida Select Option 9 Please have your patient refer to the applicable endorsement or rider issued with his or her contract, Evidence of Coverage, member handbook or certificate of coverage to determine coverage.

Through the NAIC, state insurance regulators establish standards and best practices, conduct peer reviews, and coordinate regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally.

Search NAIC. Resource Center Newsroom. For more information, please visit our Resource Center. Ask your provider if you need prior authorization for your medical care. Some providers may contact your health plan on your behalf for prior authorization. If prior authorization is required, the plan will likely need medical records from your provider.

For example, some procedures and most inpatient hospital stays require prior authorization. Many other services do not need a prior authorization. You do not need one to see your PCP or in-plan specialists. Your doctor will tell you when you need these types of care. Call your PCP, other in-network provider or us to find out if you need an OK to go have services from a provider who is not in your network.

The Health Plan may authorize and pay for out-of-network care if the service is medically necessary and the service from an in-network provider is not available. We are here to help you continue and coordinate medically necessary care when you join The Health Plan.