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words in boldface type and underscored are additions.
Regular Session, 2010 ENROLLED
SENATE BILL NO. 732
BY SENATOR HEBERT AND REPRESENTATI VE KLECKLEY
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
services pursuant to the plan or policy provisions between the enrollee or18
insured and the health insurance issuer.19
(a) In the case of a contracted health care provider, "enrollee or insured20 SB NO. 732 ENROLLED
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words in boldface type and underscored are additions.
liability" is the amount due for coinsurance, co-payments, deductibles, non-1
covered services, or any other amounts identified by the health insurance issuer2
on an explanation of benefits as an amount for which the enrollee or insured is3
liable for the covered or non-covered service.4
(b) In the case of a non-contracted health care provider, "enrollee or5
insured liability" is the amount as determined pursuant to the plan or policy6
provisions between the enrollee or insured and the health insurance issuer for7
covered and non-covered, out-of-network health care services, including but not8
limited to the enrollee's or insured's contractual deductible, coinsurance, or co-9
payment amount.10
B. (1) Health insurance issuer disclosure requirements. No later than11
July 1, 2011, each health insurance issuer shall provide the following balance12
billing disclosure notice:13
"NOTICE14
HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A15
NETWORK HEALTH CARE FACILITY BY FACILITY-BASED16
PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE17
RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR18
THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO APPLICABLE19
AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES,20
AND NON-COVERED SERVICES.21
SPECIFIC INFORMATION ABOUT IN-NETWORK AND OUT-OF-22
NETWORK FACILITY-BASED PHYSICIANS CAN BE FOUND AT THE23
WEBSITE ADDRESS OF YOUR HEALTH PLAN OR BY CALLING THE24
CUSTOMER SERVICE TELEPHONE NUMBER OF YOUR HEALTH25
PLAN".26
(2) The balance billing disclosure notice shall be disclosed in all of the27
following methods:28
(a) To the potential policyholder prior to the time the health benefit plan29
is purchased. The disclosure notice may be provided directly by the health30 SB NO. 732 ENROLLED
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insurance issuer or through an authorized insurance producer. If the health1
insurance issuer provides the disclosure notice to the producer, then the2
producer shall provide that disclosure notice to the potential policyholder.3
(b) To the policyholder and enrollees, at the time the insurance policy or4
other proof of coverage is issued, as follows:5
(i) For a group benefit plan, to the policyholder and employees at the6
time the insurance policy or other proof of insurance coverage is issued.7
(ii) For an individual benefit plan, to the policyholder at the time the8
insurance policy or other proof of insurance coverage is issued.9
(c) To the policyholder and enrollees at least once a year as follows:10
(i) For a group benefit plan, to the policyholder and employees.11
(ii) For an individual benefit plan, to the policyholder.12
(d) On the health insurance issuer's website.13
C. Facility disclosure requirements. No later than July 1, 2011, each14
health care facility shall:15
(1) Provide a written notice to an enrollee or insured at the first16
registration contact with the enrollee or insured at the health care facility17
regarding nonemergency services disclosing the following items:18
(a) Confirmation as to whether the facility is a participating provider19
contracted with the enrollee's or insured's health insurance issuer on the date20
services are to be rendered, based on the information received from the21
enrollee or insured at the time the confirmation is provided.22
(b) The following balance billing disclosure notice:23
"NOTICE24
HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A25
NETWORK HEALTH CARE FACILITY BY FACILITY-BASED26
PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE27
RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR28
THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO APPLICABLE29
AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES,30 SB NO. 732 ENROLLED
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words in boldface type and underscored are additions.
AND NON-COVERED SERVICES. SPECIFIC INFORMATION ABOUT IN-1
NETWORK AND OUT-OF-NETWORK FACILITY-BASED PHYSICIANS2
CAN BE FOUND AT THE WEBSITE ADDRESS OF YOUR HEALTH PLAN3
OR BY CALLING THE CUSTOMER SERVICE TELEPHONE NUMBER OF4
YOUR HEALTH PLAN".5
(2) Provide a list upon request from an enrollee or insured that contains6
the name and contact information for each individual or group of hospital-7
contracted anesthesiologists, pathologists, radiologists, hospitalists, intensivists,8
and neonatologists who provide services at that facility and inform the enrollee9
or insured that the enrollee or insured may request information from their10
health insurance issuer as to whether those physicians are contracted with the11
health insurance issuer and under what circumstances the enrollee or insured12
may be responsible for payment of any amounts not paid by the health13
insurance issuer.14
(3) If the facility operates a website that includes a listing of physicians15
who have been granted medical staff privileges to provide medical services at16
the facility, post on the facility's website a list that contains the name and17
contact information for each facility-based physician or facility-based physician18
group that has been granted medical staff privileges to provide medical services19
at the facility, and an update of the list within thirty days of any changes.20
D. Facility-based physician disclosure requirements. No later than July21
1, 2011, whenever a facility-based physician bills a patient who has health22
insurance coverage issued by a health insurance issuer that does not have a23
contract with the facility-based physician, the facility-based physician shall send24
a bill that includes all of the following items:25
(1) An itemized listing of the services and supplies provided by the26
facility-based physician along with the dates such services and supplies were27
provided.28
(2) The amount that is owed by the enrollee or insured and language29
conspicuously displayed on the front of such bill:30 SB NO. 732 ENROLLED
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"NOTICE: THIS IS A BILL. BASED UPON INFORMATION FROM1
YOUR HEALTH PLAN, YOU OWE THE AMOUNT SHOWN".2
(3) A telephone number to call to discuss the statement.3
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: