SLS 10RS-1082 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. 683
BY SENATOR LAFLEUR
HEALTH/ACC INSURANCE. Requires health insurance issuers to directly pay
noncontracted health care providers of emergency services for their usual and customary
charges. (8/15/10)
AN ACT1
To enact R.S. 22:1826, relative to noncontracted providers of emergency services; to require2
health insurance issuers to directly pay such providers their usual and customary3
charges for such services; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1826 is hereby enacted to read as follows: 6
ยง1826. Payment of claims for emergency services provided by noncontracted7
health care providers8
A. A health care provider that does not contract with a health insurance9
issuer may file a claim with a health insurance issuer for emergency services10
rendered. The health insurance issuer shall directly pay such a claim by a11
noncontracted provider in the amount of the provider's usual and customary12
charges paid for such emergency services, less any amount representing13
coinsurance, copayments, deductibles, noncovered services, or any other14
amounts identified by the health insurance issuer as an amount for which the15
insured or enrollee is liable. Payment of such claim by the health insurance16
issuer shall in no circumstances be made directly to the patient, insured, or17 SB NO. 683
SLS 10RS-1082 ORIGINAL
Page 2 of 2
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
enrollee.1
B. For purposes of this Section,"health insurance issuer" means any2
entity that offers health insurance coverage through a policy or certificate of3
insurance subject to state law that regulates the business of insurance. The term4
shall also include a health maintenance organization, as defined and licensed5
pursuant to Subpart I of Part I of Chapter 2 of this Title, and nonfederal6
government plans subject to the provisions of Subpart B of this Part but shall7
not include the office of group benefits.8
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Linda Nugent.
DIGEST
Proposed law authorizes a health care provider that does not contract with a health insurance
issuer to file a claim with a health insurance issuer for emergency services rendered.
Requires the health insurance issuer to directly pay such a claim by a noncontracted provider
in the amount of the provider's usual and customary charges paid for such emergency
services, less any amount representing coinsurance, copayments, deductibles, noncovered
services, or any other amounts identified by the health insurance issuer as an amount for
which the insured or enrollee is liable. Specifies that payment of such claim by the health
insurance issuer shall in no circumstances be made directly to the patient, insured, or
enrollee.
Proposed law further defines "health insurance issuer" as any entity that offers health
insurance coverage through a policy or certificate of insurance subject to state law that
regulates the business of insurance. Specifies that the term shall also include health
maintenance organizations and nonfederal government plans but shall not include the office
of group benefits.
Effective August 15, 2010.
(Adds R.S. 22:1826)