HLS 14RS-1441 ORIGINAL
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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. 895
BY REPRESENTATIVE FANNIN
INSURANCE/HEALTH: Provides relative to balance billing
AN ACT1
To enact R.S. 22:1827, relative to payment of claims for services provided by noncontracted2
healthcare providers; to provide for definitions; to provide for exemptions; and to3
provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1827 is hereby enacted to read as follows: 6
ยง1827. Payment of claims for services provided by noncontracted health care7
providers8
A.(1) If a healthcare provider that is not contracted with a health insurance9
issuer files a claim with the health insurance issuer for services rendered, the health10
insurance issuer shall directly pay the claim by the noncontracted provider in the11
amount as determined pursuant to the plan or policy provisions between the enrollee12
or insured and the health insurance issuer, less any amount representing coinsurance,13
copayments, deductibles, noncovered services, or any other amounts identified by14
the health insurance issuer pursuant to the plan or policy provisions, as an amount15
for which the insured or enrollee is liable. Payment of such claim by the health16
insurance issuer shall in no circumstances be made directly to the patient, insured,17
or enrollee.18 HLS 14RS-1441 ORIGINAL
HB NO. 895
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are additions.
(2) The healthcare provider shall have ninety days following the date the1
services were provided to seek payment from the health insurance issuer of the2
recipient of the services provided.3
(3)(a) If the healthcare provider is paid directly by the health insurance issuer4
the same amount the issuer would have paid for the services rendered had the issuer5
contracted with the provider for the services, the provider shall not seek recovery for6
any additional sums from the recipient of the services provided.7
(b) If the provider receives a lesser amount in payment directly from the8
issuer for the services rendered than the provider would have received had the9
provider contracted with the issuer, the provider may seek payment of the remainder10
of the amount from the recipient of the services.11
(4) If the healthcare provider does not seek payment from the health12
insurance issuer for the services rendered, the provider may seek full payment for the13
services rendered from the recipient of the services provided.14
B. For purposes of this Section, "health insurance issuer" means any entity15
that offers health insurance coverage through a policy or certificate of insurance16
subject to state law that regulates the business of insurance. The term shall also17
include a health maintenance organization, as defined and licensed pursuant to18
Subpart I of Part I of Chapter 2 of this Title, and nonfederal government plans19
subject to the provisions of Subpart B of this Part and the Office of Group Benefits.20
C. The provisions of this Section shall not apply to limited benefit health21
insurance policies or contracts.22 HLS 14RS-1441 ORIGINAL
HB NO. 895
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
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)]
Fannin HB No. 895
Abstract: Provides that out-of-network healthcare provider who receives directly from the
health insurance issuer payment of the same amount the out-of-network provider
would have received if in network may not seek payment of remaining balance from
the patient.
Proposed law provides that if a health insurance issuer pays the in-network amount for
services provided to an insured to an out-of-network healthcare provider, the provider may
not seek payment of the remaining balance from the insured.
(Adds R.S. 22:1827)