HLS 14RS-1140 ORIGINAL
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Regular Session, 2014
HOUSE BILL NO. 822
BY REPRESENTATIVE SEABAUGH
INSURANCE/HEALTH: Provides relative to balanced billing
AN ACT1
To amend and reenact R.S. 9:4752 and R.S. 22:1826, relative to balance billing; to provide2
relative to noncontracted healthcare providers of emergency medical services; to3
restrict judicial enforcement of balance bills; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 9:4752 is hereby amended and reenacted to read as follows:6
§4752. Privilege on net proceeds collected from third party in favor of medical7
providers for services and supplies furnished injured persons 8
A. A healthcare provider, hospital, or ambulance service that furnishes9
services or supplies to any injured person shall have a privilege for the reasonable10
charges or fees of such healthcare provider, hospital, or ambulance service, except11
as provided in Subsection B, on the net amount payable to the injured person, his12
heirs, or legal representatives, out of the total amount of any recovery or sum had,13
collected, or to be collected, whether by judgment or by settlement or compromise,14
from another person on account of such injuries, and on the net amount payable by15
any insurance company under any contract providing for indemnity or compensation16
to the injured person. The privilege of an attorney shall have precedence over the17
privilege created under this Section.18
B. The provisions of this Section and the privilege authorized herein shall19
not apply to a healthcare provider, hospital, or ambulance service that has received20 HLS 14RS-1140 ORIGINAL
HB NO. 822
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direct payment from a health insurance issuer for a covered service or claim pursuant1
to R.S. 22:1826, except to the extent any injured person is liable to the healthcare2
provider, hospital, or ambulance service for any coinsurance, copayments,3
cost-sharing, or deductibles under the terms of the injured person's health benefit4
plan.5
Section 2. R.S. 22:1826 is hereby amended and reenacted to read as follows:6
§1826. Payment of claims for emergency services provided by noncontracted health7
care providers; restriction on judicial enforcement of balance bills8
A. If a healthcare provider that does not contract with a health insurance9
issuer files a claim with a health insurance issuer for emergency services rendered10
or for claims resulting from an emergency medical condition, as defined in R.S.11
22:2392, the health insurance issuer shall directly pay such a claim by a12
noncontracted provider in the amount as determined pursuant to the plan or policy13
provisions between the enrollee or insured and the health insurance issuer, less any14
amount representing coinsurance, copayments, deductibles, noncovered services, or15
any other amounts identified by the health insurance issuer pursuant to the plan or16
policy provisions, as an amount for which the insured or enrollee is liable. Payment17
of such claim by the health insurance issuer shall in no circumstances be made18
directly to the patient, insured, or enrollee.19
B. A healthcare provider, or his mandatary or other representative, making20
a judicial demand that is unenforceable pursuant to this Section shall have no right21
of action, and such a demand shall be dismissed by a court of competent jurisdiction22
for want of a right of action under Code of Civil Procedure Article 927.23
C. No judgment, lien, or other judicial or administrative remedy of any kind24
whatsoever including but not limited to a writ of fieri facias shall be enforceable25
against a patient, insured, or enrollee, his estate, or his successors, heirs or legatees,26
for the balance of any sum in excess of the amount paid directly to a noncontracted27
provider by a health insurance issuer for services rendered or for claims resulting28
from emergency services rendered or from an emergency medical condition.29 HLS 14RS-1140 ORIGINAL
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BD. For purposes of this Section,"health insurance issuer" means any entity1
that offers health insurance coverage through a policy or certificate of insurance2
subject to state law that regulates the business of insurance. The term shall also3
include a health maintenance organization, as defined and licensed pursuant to4
Subpart I of Part I of Chapter 2 of this Title, and nonfederal government plans5
subject to the provisions of Subpart B of this Part and the Office of Group Benefits.6
CE. The provisions of this Section shall not apply to limited benefit health7
insurance policies or contracts.8
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)]
Seabaugh HB No. 822
Abstract: Provides that noncontracted healthcare providers of emergency services may not
seek payment for the balance of any sum in excess of the amount paid directly to the
noncontracted provider by the health insurance issuer for claims resulting emergency
services rendered or from an emergency medical condition. Further provides that the
healthcare privilege provided in present law does not apply to healthcare providers
that have received direct payment from a health insurance issuer for a covered
service or claim.
Present law provides a healthcare provider privilege for the fees charged for services or
supplies furnished to an injured person out of any recovery the injured person receives by
judgment, settlement, or compromise.
Proposed law provides that the healthcare provider privilege does not apply to a healthcare
provider who receives direct payment from a health insurance issuer for emergency services
provided or for an emergency medical condition.
Present law provides that a health insurance issuer directly pays a claim from a
noncontracted healthcare provider rendering emergency services.
Proposed law retains present law but also requires a health insurance issuer directly pay a
claim from a noncontracted healthcare provider treating an emergency medical condition.
Proposed law provides that a healthcare provider of emergency services may not obtain a
judicial order for the balance of any sum in excess of the amount directly paid to a
noncontracted provider by a health insurance issuer for emergency services rendered or for
treatment of an emergency medical condition.
(Amends R.S. 9:4752 and R.S. 22:1826)