SLS 12RS-815 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, 2012
SENATE BILL NO. 578
BY SENATOR WARD
INSURANCE CLAIMS. Provides for payment for certain emergency room services.
(8/1/12)
AN ACT1
To amend and reenact R.S. 22:1826(A) and to enact 1826(D), relative to payment of claims2
for emergency services provided by noncontracted health care providers; to provide3
with respect to billing by certain noncontracted physicians; to provide for amounts4
paid by health insurance issuers in certain cases; to prohibit billing by certain5
noncontracted physicians for emergency services; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:1826(A) is hereby amended and reenacted and 1826(D) is hereby8
enacted to read as follows:9
ยง1826. Payment of claims for emergency services provided by noncontracted health10
care providers11
A. If a health care provider that does not contract with a health insurance12
issuer files a claim with a health insurance issuer for emergency services rendered,13
the health insurance issuer shall directly pay such a claim by a noncontracted14
provider in the amount as determined pursuant to the plan or policy provisions15
between the enrollee or insured and the health insurance issuer, less any amount16
representing coinsurance, copayments , deductibles, noncovered services, or any17 SB NO. 578
SLS 12RS-815 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
other amounts identified by the health insurance issuer pursuant to the plan or policy1
provisions, as an amount for which the insured or enrollee is liable. However, if the2
provider is a noncontracted emergency room physician, the amount payable by3
the health insurance issuer shall be as provided in Subsection D of this Section.4
Payment of such claim by the health insurance issuer shall in no circumstance5
be made directly to the patient, insured, or enrollee.6
* * *7
D.(1) Notwithstanding any other provision of law to the contrary,8
including but not limited to R.S. 22:263(D), if a health insurance issuer is liable9
for emergency services provided by a noncontracted emergency room physician10
to an enrollee or insured who has been transported to the facility by emergency11
medical transportation, the issuer's liability and the enrollee or insured's12
liability shall be calculated using the greatest of the following:13
(a) The amount negotiated with in-network providers for the emergency14
service furnished.15
(b) The amount for the emergency service calculated using the same16
method the issuer uses to determine payments for out-of-network services.17
(c) The Medicare allowable charge for the emergency service.18
(2) The noncontracted emergency room physician shall be prohibited19
from discount billing, dual billing, attempting to collect from, or collecting from20
an enrollee or insured the amount owed by the health insurance issuer as21
provided in Paragraph (1) of this Subsection or any amount in excess of the22
enrollee or insured's liability as identified on the explanation of benefits23
received by the physician from the health insurance issuer.24
Section 2. This Act shall become effective upon signature by the governor or, if not25
signed by the governor, upon expiration of the time for bills to become law without signature26
by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If27
vetoed by the governor and subsequently approved by the legislature, this Act shall become28
effective on the day following such approval.29 SB NO. 578
SLS 12RS-815 ORIGINAL
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Present law provides that a health care provider that does not contract with a health
insurance issuer filing a claim for emergency services rendered, then the health insurance
issuer shall directly pay such a claim in the amount determined pursuant to the plan or policy
provisions between the insured and the health insurance issuer, 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 is liable.
Proposed law retains present law and further provides that if a health insurance issuer is
liable for emergency services provided by a noncontracted emergency room physician to an
insured who has been transported to the facility by emergency medical transportation, the
issuer's liability and the insured's liability shall be calculated using the greatest of:
(1)The amount negotiated with in-network providers for the emergency service
furnished.
(2)The amount for the emergency service calculated using the same method the issuer
uses to determine payments for out-of-network services.
(3)The Medicare allowable charge for the emergency service.
Proposed law further provides that the noncontracted emergency room physician shall be
prohibited from discount billing, dual billing, attempting to collect from, or collecting from
an enrollee or insured the amount owed by the health insurance issuer as provided in
proposed law or any amount in excess of the enrollee or insured's liability as identified on
the explanation of benefits received by the physician from the health insurance issuer.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1826(A); adds R.S. 22:1826(D))