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)]
HB 702 Original 2015 Regular Session Thierry
Abstract: Requires a health insurance issuer to cover contested healthcare services, including
prescription drugs, during the appeal or review of an adverse determination.
Present law provides for various levels of review and appeal of adverse determinations by health
insurance issuers. Generally defines an adverse determination as the denial, reduction, termination,
or failure to pay or provide for a benefit under a covered person's health benefit plan.
Proposed law provides that, notwithstanding any other provision of present law to the contrary,
notice of an adverse determination or a final adverse determination shall be provided by a health
insurance issuer to a covered person no later than the thirtieth day before the date on which the
healthcare services that are the subject of the appeal or review will be discontinued.
Proposed law provides that, notwithstanding any other provision of present law to the contrary, the
procedures for appealing any adverse determination shall:
(1) Require that coverage or benefits for the contested healthcare services, including
prescription drugs, that are the subject of the adverse determination continues under
the covered person's health benefit plan while the appeal or review is being
considered to the same extent and in the same manner as if no adverse determination
had been made or upheld.
(2)Require, without regard to whether the adverse determination is upheld on appeal or
review, any health insurance issuer to cover the contested healthcare services,
including prescription drugs, received during the period that the appeal was
considered to the same extent and in the same manner, including the same benefit
level, as if no adverse determination had been made or upheld.
(3) Prohibit, without regard to whether the adverse determination is upheld on appeal or
review, any health insurance issuer from recouping, based upon an adverse
determination, any payment made to a healthcare provider pursuant to the continued
coverage or benefits specified in proposed law.
Proposed law provides that it shall apply only to an adverse determination made in relation to
coverage or benefits under a health benefit plan delivered, issued for delivery, or renewed on or after
Jan. 1, 2016, and shall not apply to an adverse determination made in relation to coverage or benefits
under a health plan delivered, issued for delivery, or renewed before Jan. 1, 2016. Effective on January 1, 2016.
(Adds R.S. 22:2396 and 2397 )