HLS 17RS-272 ORIGINAL
2017 Regular Session
HOUSE BILL NO. 435
BY REPRESENTATIVE TALBOT
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE/HEALTH: Requires disclosure to patient of out-of–network providers prior
to surgery
1 AN ACT
2To enact R.S. 22:1880(E), relative to balance billing disclosure; to require that a healthcare
3 facility disclose to a patient out-of-network providers prior to nonemergency
4 surgery; to provide for opportunities for a patient to obtain in-network providers; to
5 provide for penalties for failure to disclose; and to provide for related matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1880(E) is hereby enacted to read as follows:
8 §1880. Balance billing disclosure
9 * * *
10 E.(1) Facility disclosure requirements prior to nonemergency surgery. Each
11 healthcare facility providing surgical services shall:
12 (a) Provide a written notice to an enrollee or insured no later than seventy-
13 two hours prior to the scheduled date of a nonemergency surgical procedure
14 disclosing all of the following items:
15 (i) Confirmation as to whether the facility is a participating provider
16 contracted with the enrollee's or insured's health insurance issuer on the date services
17 are to be rendered, based on the information received from the enrollee or insured
18 at the time the confirmation is provided.
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CODING: Words in struck through type are deletions from existing law; words underscored
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HB NO. 435
1 (ii) The following balance billing disclosure notice:
2 "NOTICE
3 HEALTH CARE SERVICES MAY BE PROVIDED TO YOU BY
4 FACILITY-BASED PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN.
5 YOU MAY BE RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE
6 FEES FOR THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO
7 APPLICABLE AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE,
8 DEDUCTIBLES, AND NON-COVERED SERVICES. SPECIFIC INFORMATION
9 ABOUT IN-NETWORK AND OUT-OF-NETWORK FACILITY-BASED
10 PHYSICIANS CAN BE FOUND AT THE WEBSITE ADDRESS OF YOUR
11 HEALTH PLAN OR BY CALLING THE CUSTOMER SERVICE TELEPHONE
12 NUMBER OF YOUR HEALTH PLAN. YOU HAVE THE RIGHT TO
13 SUBSTITUTE IN-NETWORK PROVIDERS TO PERFORM THE SAME
14 SERVICES AS OUT-OF-NETWORK PROVIDERS DURING YOUR SURGICAL
15 PROCEDURE."
16 (iii) A list of all facility-based providers who will be providing services
17 during the surgical procedure whose services are not included in the fee charged by
18 the healthcare facility and who will bill the enrollee or insured separately, and
19 whether each such provider is a participating provider contracted with the enrollee's
20 or insured's health insurance provider.
21 (b) Provide a list upon request from an enrollee or insured that contains the
22 name and contact information for each individual or group of hospital-contracted
23 anesthesiologists, pathologists, radiologists, hospitalists, intensivists, and
24 neonatologists who provide services at that facility and inform the enrollee or
25 insured that the enrollee or insured may request information from his health
26 insurance issuer as to whether those providers are contracted with the health
27 insurance issuer and under what circumstances the enrollee or insured may be
28 responsible for payment of any amounts not paid by the health insurance issuer.
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CODING: Words in struck through type are deletions from existing law; words underscored
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HB NO. 435
1 (c) If the facility operates a website that includes a listing of providers who
2 have been granted medical staff privileges to provide medical services at the facility,
3 post on the facility's website a list that contains the name and contact information for
4 each facility-based provider or facility-based provider group that has been granted
5 medical staff privileges to provide medical services at the facility, and an update of
6 the list within thirty days of any changes.
7 (2) Failure by the healthcare facility to provide the notice required by this
8 Subsection shall require the healthcare facility to be responsible for the portion of the
9 out-of-network provider's fee not covered by the enrollee's or insured's health
10 insurance plan, including but not limited to the enrollee's or insured's contractual
11 deductible, coinsurance, or co-payment amount.
12 (3)(a) Violations of this Subsection shall be deemed an unfair trade practice
13 pursuant to Part IV of Chapter 7 of the Louisiana Revised Statutes of 1950,
14 R.S. 22:1961 et seq.
15 (b) The commissioner shall have the power to enforce the provisions of this
16 Subsection pursuant to the powers granted to the commissioner by that Part.
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 435 Original 2017 Regular Session Talbot
Abstract: Requires that a healthcare facility advise a patient at least 72 hours prior to the
scheduled date of a nonemergency surgery of the use of out-of-network medical
providers.
Present law requires that a healthcare facility provide a written notice to a patient regarding
the possible provision of services to a patient by facility-based providers who are out-of-
network providers. Present law further requires that the patient be informed in the written
notice that the patient may be responsible for all or part of the fees for out-of-network
services.
Proposed law retains present law and further requires that at least 72 hours prior to a
scheduled nonemergency surgery the healthcare facility provide a written notice to the
patient of all providers who will be providing services during the surgical procedure whose
fees are not included in the fees charged by the facility. Further provides that the healthcare
facility include whether these additional providers are in the patient's network or are out-of-
network providers.
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HB NO. 435
Proposed law provides a patient an opportunity to replace out-of-network healthcare
providers with in-network healthcare providers.
Proposed law provides that a healthcare facility that fails to provide a patient with the
required notice will be responsible for the patient's fees not covered by the patient's health
insurance provider.
Proposed law provides that violations are an unfair trade practice and may be investigated
and penalized by the commissioner pursuant to the unfair trade practices provision in the
Insurance Code, R.S. 22:1961 et seq.
(Adds R.S. 22:1880(E))
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.