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No Surprises Act IDR in Florida

IDR filing for Florida providers: which claims go federal, which go state

Florida is consistently the second-largest source of federal IDR disputes. Its state law covers insured plans and most HMO claims; self-funded plans and lower-dollar HMO claims go federal.

Federal IDR or the Florida state process?

Florida is bifurcated. Florida Statutes §627.64194 (PPO/insured plans) and §641.513 (HMOs) set out-of-network payment for state-regulated coverage, and disputes above certain claim thresholds go through the Florida statewide provider-and-health-plan claim dispute resolution program. Self-funded ERISA plans, and HMO claims below the state thresholds, go to federal IDR.

The rule of thumb in every bifurcated state: the state law governs plans the state regulates (fully insured employer plans, individual/marketplace plans, and usually HMOs). Self-funded employer plans under ERISA — the majority of commercial coverage — go through federal IDR unless the plan has affirmatively opted into the state process where that's allowed. Getting this wrong is the #1 reason disputes are thrown out as ineligible.

What the numbers look like

  • Florida ranked second nationally in federal IDR initiations in 2023 and 2024 (nearly 40,000 emergency/non-emergency disputes in Q4 2023).
  • Florida, Texas, Georgia, and Virginia together produced the majority of all federal disputes in that period.
  • Emergency medicine and hospital-based specialties in South Florida, Tampa Bay, and Orlando drive most of it.

What we do for Florida groups

  • Determine plan type and threshold status before anything is filed
  • Run open negotiation and federal IDR on every eligible claim, batched by payer
  • Track Florida payers' post-award payment and escalate late payments

Not sure which process applies?

Send 90 days of out-of-network remits and we'll tell you claim by claim: federal IDR, Florida state process, or not disputable — plus what similar disputes have paid.

Free claims review

Related

How the federal IDR process works
IDR data & benchmarks
Other states

Find out what your out-of-network claims are actually worth.

Send us a sample of recent OON remits. We'll tell you which claims are IDR-eligible, what similar disputes have paid, and what we'd file. No fee unless we win you more.

Request a free eligibility review