HLS 17RS-913 ENGROSSED
2017 Regular Session
HOUSE BILL NO. 188
BY REPRESENTATIVE CROMER
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Provides for review of fees charged for external review
1 AN ACT
2To amend and reenact R.S. 22:2444, relative to the funding of an external review of a health
3 insurance issuer; to provide that the issuer pay the cost of the review; to provide for
4 documentation of the costs; to provide for appeal; and to provide for related matters.
5Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:2444 is hereby amended and reenacted to read as follows:
7 ยง2444. Funding of external review
8 A. The health insurance issuer against which a request for a standard external
9 review or an expedited external review is filed shall pay the cost of the independent
10 review organization for conducting the external review, and no fee or other charge
11 may be levied upon a covered person for any costs of an external review.
12 B.(1) The amount charged by the independent review organization as the
13 cost to be paid by the health insurance issuer shall be a reasonable amount for the
14 actual review performed. The independent review organization shall provide
15 adequate documentation to the health insurance issuer justifying the amount charged.
16 (2) A health insurance issuer that believes that the amount charged for a
17 review by an independent review organization is not reasonable may appeal those
18 charges to the commissioner. In conducting the appeal, the commissioner shall
19 review the amount charged, make a determination regarding the reasonableness of
20 the amount charged, and, if warranted, may order an appropriate reduction. The
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 17RS-913 ENGROSSED
HB NO. 188
1 commissioner may request additional information from the independent review
2 organization, the health insurance issuer, or other independent review organizations
3 or healthcare providers in making his determination.
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 188 Engrossed 2017 Regular Session Cromer
Abstract: Provides for the funding and appeal, if necessary, of the costs of an external
review of a health insurance issuer.
Present law requires that when a covered person requests an external review of his health
insurance issuer, the issuer pay the cost to conduct the review.
Proposed law retains present law and further requires that the costs of the external review
charged to the issuer must be reasonable and that the independent review organization
provide documentation outlining an explanation of costs.
Proposed law provides that when an issuer believes that the cost of the external review are
unreasonable, he can appeal to the commissioner of insurance, who may make an
adjustment, if appropriate. Proposed law allows the commissioner to request additional
information if necessary to assess the reasonableness of the costs.
(Amends R.S. 22:2444)
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.