Concerns with Third-party Payers
The FDA has a dedicated staff member to focus resources on third-party payers in Florida and their impact on members. Working closely with the various insurance plans, Medicaid managed-care plans, the Agency for Health Care Administration (AHCA), Department of Health, Board of Dentistry (BOD), and other state and federal agencies, the FDA Director of Third Party Payer and Professional Affairs addresses issues relating to third-party payers.
Looking for help?
Call the FDA! We can address your concerns in the complex arena of managed care. We also can gather data on problems and create momentum for finding solutions.
Make the call!
Call with issues and concerns about:
- Insurance and Medicaid managed-care plan reimbursement
- Contracting with commercial insurance and Medicaid managed-care plans
- Filing complaints with the Office of Insurance Regulation and/or AHCA
- General third-party payer questions
- Regulatory issues with the BOD
Real Problem Solving — An Example
A Medicaid managed-care plan sent letters to members that restricted patient care (e.g., limiting dental sealant use and children's X-rays; placing an age limit on permanent crowns; and, denying coverage for immediate dentures). After careful evaluation, FDA staff determined that the plan was unlawfully restricting care and contacted AHCA. The agency then told the plan it could not restrict care to Medicaid recipients.
For additional information:
Director of Third Party Payer & Professional Affairs