SLS 10RS-844 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2010
SENATE BILL NO. 349
BY SENATOR LAFLEUR
HEALTH/ACC INSURANCE. Provides for the prohibition of balance billing. (8/15/10)
AN ACT1
To amend and reenact R.S. 22:1874(A)(4) and to enact R.S. 22:1874(A)(5), relative to the2
prohibition of balance billing; and to provide for related matters.3
Be it enacted by the Legislature of Louisiana:4
Section 1. R.S. 22:1874(A)(4) is hereby amended and R.S. 22:1874(A)(5) is hereby5
enacted to read as follows: 6
ยง1874. Billing by contracted health care providers7
A.(1)8
* * *9
(4) A health insurance issuer contracting with a network of providers is10
obligated to pay to a contracted health care provider the contracted reimbursement11
rate of the network identified on the member identification card of the enrollee or12
insured, pursuant to R.S. 40:2203.1, and established by the contract between the13
network of providers and the contracted health care provider. The payor must14
comply with all provisions of the specific network contract. To the extent that a15
health insurance issuer does not pay to the health care provider an amount equal to16
the health insurance issuer liability, the contracted health care provider may collect17 SB NO. 349
SLS 10RS-844 ORIGINAL
Page 2 of 3
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
the difference between the amount paid by the health insurance issuer and the health1
insurance issuer liability from the enrollee or insured. Any such collection efforts2
shall not constitute a violation of this Subpart.3
(5) A health insurance issuer is obligated to pay for covered health care4
services, including, but not limited to all reasonably anticipated ancillary5
services rendered in connection with treatment to its enrollee or insured at an6
in-network base health care facility. The enrollee or insured's liability shall be7
limited to the in-network copayment, deductible, coinsurance, or amounts due8
for noncovered health care services. For any covered health care services9
rendered pursuant to this Paragraph, the provider notice provisions of R.S.10
22:1873(A)(1) through (4) shall apply to any bill or activity statement sent to an11
enrollee or insured by a noncontracted health care provider.12
* * *13
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Present law requires a health insurance issuer contracting with a network of providers to pay
a contracted health care provider the contracted reimbursement rate of the network identified
on the member identification card of the enrollee or insured and established by the contract
between the network of providers and the contracted health care provider. Proposed law
retains this provision.
Present law provides that to the extent that a health insurance issuer does not pay the health
care provider an amount equal to the issuer liability, the contracted health care provider may
collect the difference between the amount paid by the issuer and the issuer liability from the
enrollee or insured. Proposed law deletes this provision and allows the contracted health
care provider to collect the difference between the amount paid by the issuer and the issuer
liability from the enrollee or insured.
Proposed law requires a health insurance issuer to pay for the covered health care services,
including, but not limited to all reasonably anticipated ancillary services rendered in
connection with treatment to its enrollee or insured at an in-network base health care facility. SB NO. 349
SLS 10RS-844 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Proposed law limits the enrollee or insured's liability to the in-network copayment,
deductible, coinsurance, or amounts due for noncovered health care services. Requires
compliance with notice provisions in present law to apply to any bill or activity statement
sent to an enrollee or insured by a noncontracted health care provider.
Effective August 15, 2010.
(Amends R.S. 22:1874(A)(4); adds R.S. 22: 1874(A)(5))