HLS 14RS-161 ENGROSSED
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2014
HOUSE BILL NO. 601
BY REPRESENTATIVES ABRAMSON, HUNTER, HUVAL, PIERRE, RITCHIE, AND
THIBAUT
INSURANCE/HEALTH: Prohibits a provider of healthcare services from refusing to
submit a claim to a health insurance issuer under certain circumstances
AN ACT1
To enact R.S. 22:1827, relative to health insurance coverage; to prohibit a provider of2
healthcare services from refusing to submit a claim to a health insurance issuer under3
certain circumstances; to define certain terms; to provide that certain conflicting4
provisions in agreements between a provider of healthcare services and a health5
insurance issuer shall be deemed null and void; and to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:1827 is hereby enacted to read as follows:8
ยง1827. Submission of health insurance claims9
A.(1) A provider of healthcare services shall not require an insured, as a10
condition for the submission of a claim for payment by a health insurance issuer, to11
consent to full payment for the healthcare services in the event that the insured's12
health insurance issuer denies such claim for healthcare services.13
(2) This Section shall not preclude such a provider from requiring the14
insured to pay the provider directly for such healthcare services in the event such a15
claim is subsequently denied by the health insurance issuer after submission but16
before the services are provided and such services are still requested by the insured.17 HLS 14RS-161 ENGROSSED
HB NO. 601
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
B. For purposes of this Section:1
(1) "Healthcare services" means services, items, supplies, or drugs for the2
diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury,3
or disease.4
(2) "Health insurance coverage" means benefits consisting of medical care5
provided or arranged for directly, through insurance or reimbursement, or otherwise,6
and includes healthcare services paid for under any plan, policy, or certificate of7
insurance.8
(3) "Health insurance issuer" means any entity that offers health insurance9
coverage through a policy or certificate of insurance subject to state law that10
regulates the business of insurance. For purposes of this Subpart, a "health insurance11
issuer" shall include a health maintenance organization, as defined and licensed12
pursuant to Subpart I of Part I of Chapter 2 of this Title, nonfederal government13
plans subject to the provisions of Subpart B of this Part, and the Office of Group14
Benefits.15
C. Any provision in an agreement between a provider of healthcare services16
and a health insurance issuer that conflicts with the provisions of this Section shall17
be deemed null and void.18
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Abramson HB No. 601
Abstract: Prohibits healthcare providers from refusing to submit a claim to a health
insurance issuer under certain circumstances.
Proposed law prohibits a provider of healthcare services from requiring an insured, as a
condition for the submission of a claim for payment by a health insurance issuer, to consent
to full payment for such healthcare services in the event that the insured's health insurance
issuer denies such claim.
Proposed law provides that it shall not preclude a provider of healthcare services from
requiring an insured to pay for healthcare services directly to the provider if the claim is
denied after submission to the health insurance issuer but before the services are provided
if still requested by the insured. HLS 14RS-161 ENGROSSED
HB NO. 601
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Proposed law defines terms "healthcare services", "health insurance coverage", and "health
insurance issuer".
Proposed law provides that any provision in an agreement between a provider of healthcare
services and a health insurance issuer that conflicts with proposed law shall be deemed null
and void.
(Adds R.S. 22:1827)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original
bill.
1. Deletes provision prohibiting a provider of healthcare services from requiring an
insured, as a condition for furnishing such services, to consent to full payment
for such services in the event that the insured's health insurance issuer denies a
claim for such services.
2. Adds provision making any provision in an agreement between a provider of
healthcare services and a health insurance issuer that conflicts with proposed law
null and void.