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words in boldface type and underscored are additions.
Regular Session, 2010
SENATE BILL NO. 732
BY SENATOR HEBERT
HEALTH/ACC INSURANCE. Provides for balance billing disclosure requirements.
(8/15/10)
AN ACT1
To enact R.S. 22:1880, relative to health insurance; to provide for balance billing disclosure;2
to provide for definitions; to provide with respect to health insurance issuer, facility,3
and facility-based physician disclosure; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1880 is hereby enacted to read as follows: 6
ยง1880. Balance billing disclosure7
A. Definitions. As used in this Section, the following terms shall be8
defined as follows:9
(1) "Balance billing" means any written or electronic communication10
by a non-contracted health care provider that appears to attempt to collect from11
an enrollee or insured any amount for covered, non-covered, and out-of-12
network health care services received by the enrollee or insured from the non-13
contracted health care provider that is not fully paid by the enrollee or insured,14
or the health insurance issuer.15
(2) "Enrollee or insured liability" means the financial liability of an16
enrollee or insured for covered, non-covered, and out-of-network health care17 SB NO. 732
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words in boldface type and underscored are additions.
services pursuant to the plan or policy provisions between the enrollee or1
insured and the health insurance issuer.2
(a) In the case of a contracted health care provider, "enrollee or insured3
liability" is the amount due for coinsurance, co-payments, deductibles, non-4
covered services, or any other amounts identified by the health insurance issuer5
on an explanation of benefits as an amount for which the enrollee or insured is6
liable for the covered or non-covered service.7
(b) In the case of a non-contracted health care provider, "enrollee or8
insured liability" is the amount as determined pursuant to the plan or policy9
provisions between the enrollee or insured and the health insurance issuer for10
covered and non-covered, out-of-network heath care services, including but not11
limited to the enrollee or insured's contractual deductible, coinsurance or co-12
payment amount.13
B. (1) Health insurance issuer disclosure requirements. No later than14
July 1, 2011, each health insurance issuer shall provide the following balance15
billing disclosure notice:16
"NOTICE17
HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A18
NETWORK HEALTH CARE FACILITY BY FACILITY-BASED19
PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE20
RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR21
THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO APPLICABLE22
AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES23
AND NON-COVERED SERVICES.24
SPECIFIC INFORMATION ABOUT IN-NETWORK AND OUT-OF-25
NETWORK FACILITY-BASED PHYSICIANS CAN BE FOUND AT THE26
WEBSITE ADDRESS OF YOUR HEALTH PLAN OR BY CALLING THE27
CUSTOMER SERVICE TELEPHONE NUMBER OF YOUR HEALTH28
PLAN."29 SB NO. 732
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(2) The balance billing disclosure notice shall be disclosed in all of the1
following methods:2
(a) To the potential policyholder prior to the time the health benefit plan3
is purchased. The disclosure notice may be provided directly by the health4
insurance issuer or through an authorized insurance producer. If the health5
insurance issuer provides the disclosure notice to the producer, then the6
producer shall provide that disclosure notice to the potential policyholder.7
(b) To the policyholder and enrollees, at the time the insurance policy or8
other proof of coverage is issued, as follows:9
(i) For a group benefit plan, to the policyholder and employees at the10
time the insurance policy or other proof of insurance coverage is issued.11
(ii) For an individual benefit plan, to the policyholder at the time the12
insurance policy or other proof of insurance coverage is issued.13
(c) To the policyholder and enrollees at least once a year as follows:14
(i) For a group benefit plan, to the policyholder and employees.15
(ii) For an individual benefit plan, to the policyholder.16
(d) On the health insurance issuer's website.17
C. Facility disclosure requirements. No later than July 1, 2011, each18
health care facility shall provide all of the following items:19
(1) A written notice to an enrollee or insured at the first registration20
contact with the enrollee or insured at the health care facility regarding non-21
emergency services disclosing the following items:22
(a) Confirmation as to whether the facility is a participating provider23
contracted with the enrollee's or insured's health insurance issuer on the date24
services are to be rendered, based on the information received from the25
enrollee or insured at the time the confirmation is provided.26
(b) The following balance billing disclosure notice:27
"NOTICE28
HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A29 SB NO. 732
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words in boldface type and underscored are additions.
NETWORK HEALTH CARE FACILITY BY FACILITY-BASED1
PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE2
RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR3
THOSE OUT-OF-NETWOR K SERVICES, IN ADDITION TO APPLICABLE4
AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES5
AND NON-COVERED SERVICES. SPECIFIC INFORMATION ABOUT IN-6
NETWORK AND OUT-OF-NETWORK FACILITY-BASED PHYSICIANS7
CAN BE FOUND AT THE WEBSITE ADDRESS OF YOUR HEALTH PLAN8
OR BY CALLING THE CUSTOMER SERVICE TELEPHONE NUMBER OF9
YOUR HEALTH PLAN."10
(2) A list upon request from an enrollee or insured that contains the11
name and contact information for each individual or group of hospital-12
contracted anesthesiologists, pathologists, radiologists, hospitalists, intensivists,13
and neonatologists who provide services at that facility; and inform the enrollee14
or insured that the enrollee or insured may request information from their15
health insurance issuer as to whether those physicians are contracted with the16
health insurance issuer and under what circumstances the enrollee or insured17
may be responsible for payment of any amounts not paid by the health18
insurance issuer.19
(3) If the facility operates a website that includes a listing of physicians20
who have been granted medical staff privileges to provide medical services at21
the facility, post on the facility's website a list that contains the name and22
contact information for each facility-based physician or facility-based physician23
group that has been granted medical staff privileges to provide medical services24
at the facility, and an update of the list within thirty days of any changes.25
D. Facility-based physician disclosure requirements. No later than July26
1, 2011, whenever a facility-based physician bills a patient who has health27
insurance coverage issued by a health insurance issuer that does not have a28
contract with the facility-based physician, the facility-based physician shall send29 SB NO. 732
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words in boldface type and underscored are additions.
a bill that includes all of the following items:1
(1) An itemized listing of the services and supplies provided by the2
facility-based physician along with the dates such services and supplies were3
provided.4
(2) The amount that is owed by the enrollee or insured and language5
conspicuously displayed on the front of such bill:6
"NOTICE: THIS IS A BILL. BASED UPON INFORMATION FROM7
YOUR HEALTH PLAN, YOU OWE THE AMOUNT SHOWN."8
(3) A telephone number to call to discuss the statement.9
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Proposed law defines "balance billing" and "enrollee or insured liability" as it relates to
balance billing disclosure.
Proposed law requires each health insurer, no later than July 1, 2011, to provide the balance
billing disclosure notice specified in "proposed law".
Proposed law requires a health insurance issuer to disclose the balanced billing notice in the
following methods:
(1)To the potential policyholder prior to the time the health benefit plan is purchased.
(2)To the policyholder and enrollees, at the time the insurance policy or other proof of
coverage is issued. For a group benefit plan, disclosure is required at the time the
policy or proof of coverage is issued and for individual benefit plans, to the
policyholder at the time the policy or proof of coverage is issued.
(3)To the policyholder and enrollees at least once a year.
(4)On the health insurance issuer's website.
Proposed law requires each health care facility, no later than July 1, 2011, to provide all of
the following items:
(1)Written disclosure to each enrollee or insured at the first registration contact with the
enrollee or insured at the health care facility regarding non-emergency services,
which disclosure confirms whether the facility is a participating provider contracted
with the enrollee's or insured's health insurance issuer on the date the services are to
be rendered.
(2)Written notice specified in proposed law.
(3)A list, upon request of the enrollee or insured, that contains the name and contact
information for each individual or group of hospital-contracted physicians,
anesthesiologists, pathologists, radiologists, hospitalists, intensivists, and SB NO. 732
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neonatologists who provide services at that facility. Requires informing the enrollee
or insured that the enrollee or insured may request information from their health
insurance issuer as to whether those physicians are contracted with the health
insurance issuer and under what circumstances the enrollee or insured may be
responsible for payment of any amounts not paid by the health insurance issuer.
(4)If the facility operates a website that includes a listing of physicians who have been
granted medical staff privileges to provide medical services at the facility, the
facility's website shall include a list that contains the name and contact information
for each facility-based physician or facility-based physician group that has been
granted medical staff privileges as well as an update of the list within 30 days of any
change.
Proposed law provides that if a facility-based physician bills a patient who has health
insurance coverage issued by a health insurance issuer that does not have a contract with the
facility-based physician, then requires physician to send a bill that includes an itemized list
of the services and supplies provided by him as well as the dates such services and supplies
were provided. Requires disclosure of the amount owed by the enrollee or insured, a
telephone number to call to discuss the statement and language conspicuously displayed on
the front of the bill stating that it is a bill and that based on information from the health plan,
the amount shown is owed by the enrollee or insured.
Effective August 15, 2010.
(Adds R.S. 22:1880)