ENROLLED
2017 Regular Session
HOUSE BILL NO. 188
BY REPRESENTATIVE CROMER
1 AN ACT
2 To 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.
5 Be 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
21 commissioner may request additional information from the independent review
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HB NO. 188 ENROLLED
1 organization, the health insurance issuer, or other independent review organizations
2 or healthcare providers in making his determination.
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.