RÉSUMÉ DIGEST
HR 149 2015 Regular Session Robert Johnson
Urges and requests the La. Department of Insurance to study the appeals process and its
impact on those with critical illnesses and to report findings and recommendations to the
House Committee on Insurance on or before Jan. 15, 2016.
Specifies that the following factors be included in the study: how many adverse
determinations, not based on formulary changes, are made during one year in this state; how
many appeals are filed based on such adverse determinations; the average length of such an
appeal; how many of these appeals are upheld or overturned; the average notification time
of the adverse decision; whether the person's physician is consulted prior to making the
adverse determination; and what factors are considered when an adverse determination is
made due to the health insurer finding a medication medically unnecessary.