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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 charges as determined
pursuant to the plan or policy of enrollee and insurer. (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 pursuant to a plan or policy3
provisions 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. If a health care provider that does not contract with a health9
insurance issuer files a claim with a health insurance issuer for emergency10
services rendered, the health insurance issuer shall directly pay such a claim by11
a noncontracted provider in the amount as determined pursuant to the plan or12
policy provisions between the enrollee or insured and the health insurance13
issuer, less any amount representing coinsurance, copayments, deductibles,14
noncovered services, or any other amounts identified by the health insurance15
issuer pursuant to the plan or policy provisions, as an amount for which the16
insured or enrollee is liable. Payment of such claim by the health insurance17 SB NO. 683
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
issuer shall in no circumstances be made directly to the patient, insured, or1
enrollee.2
B. For purposes of this Section,"health insurance issuer" means any3
entity that offers health insurance coverage through a policy or certificate of4
insurance subject to state law that regulates the business of insurance. The term5
shall also include a health maintenance organization, as defined and licensed6
pursuant to Subpart I of Part I of Chapter 2 of this Title, and nonfederal7
government plans subject to the provisions of Subpart B of this Part and the8
office of group benefits.9
C. The provisions of this Section shall not apply to limited benefit health10
insurance policies or contracts.11
The original instrument was prepared by Linda Nugent. The following digest,
which does not constitute a part of the legislative instrument, was prepared
by Cheryl Horne.
DIGEST
LaFleur (SB 683)
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 as determined pursuant to the plan or policy provisions between the enrollee
or insured and the health insurance issuer for such emergency services, less any amount
representing coinsurance, copayments, deductibles, noncovered services, or any other
amounts identified by the health insurance issuer pursuant to the plan or policy 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 and shall include the office of
group benefits.
Proposed law exempts the provisions of proposed law from limited benefit health insurance
policies or contracts.
Effective August 15, 2010.
(Adds R.S. 22:1826) SB NO. 683
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original
bill.
1. Removes provision that payments be as the usual and customer charges and
be paid pursuant to the plan or policy provisions between the enrollee or
insured and the health insurance issuer.
2. Includes the office of group benefits.
3. Excludes limited benefit health insurance policies or contracts.