NU Online News Service, April 25, 2003, 12:19 p.m. EDT – A Florida state appeals court in Tallahassee, Fla., has ruled 3-0 in favor of efforts by American Medical Security Group Inc., Green Bay, Wis., to continue to do business in Florida.
Florida insurance regulators have been trying since July 2002 to suspend American Medical’s license to operate in the state for one year.
The Florida 1st District Court of Appeal stayed the regulators’ suspension order while American Medical appealed the order.
The appeals court now has reversed the suspension order and reaffirmed an administration law judge opinion that found that American Medical had violated no Florida laws.
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Judge James Wolf, in an opinion for the three-judge appeals court panel, contends that the Florida laws governing health insurance pricing are too ambiguous to prohibit out-of-state group health insurers from taking claims history and other factors into account when setting prices.
“The decision supports our firm belief that we are and have been operating lawfully in Florida and everywhere we do business,” Samuel Miller, chairman of American Medical, says in a statement about the new ruling.
“Florida is an important market for us,” Miller adds. “The court’s opinion should serve as validation for our customers and agents of our continuing viability and vitality in that state.”
In 2001, Florida regulators accused American Medical, which sells health insurance to individuals, families and small groups, of violating Florida’s health insurance pricing rules by using a “tier pricing” system. The system divided consumers into large groups based on health status and offered lower prices to consumers in the healthier tiers.