ENROLLED
ACT No. 306
2017 Regular Session
HOUSE BILL NO. 435
BY REPRESENTATIVE TALBOT
1 AN ACT
2 To amend and reenact R.S. 22:1880(C)(1) and (2) and to enact R.S. 22:1880(C)(4) and (E),
3 relative to balance billing disclosure; to require that a healthcare facility disclose to
4 a patient out-of-network providers; to provide for notice to insureds of possible
5 balance billing at first registration with a healthcare facility; to provide for penalties
6 for failure to disclose; and to provide for related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1880(C)(1) and (2) are hereby amended and reenacted and R.S.
9 22:1880(C)(4) and (E) are hereby enacted to read as follows:
10 ยง1880. Balance billing disclosure
11 * * *
12 C. Facility disclosure requirements. Each health care healthcare facility
13 shall:
14 (1) Provide a written notice to an enrollee or insured at the first registration
15 contact with the enrollee or insured at the health care healthcare facility regarding
16 nonemergency services. A copy of the written notice shall be signed by the enrollee
17 or insured and be maintained by the healthcare facility. disclosing The written notice
18 shall disclose the following items:
19 (a) Confirmation as to whether the facility is a participating provider
20 contracted with the enrollee's or insured's health insurance issuer on the date services
21 are to be rendered, based on the information received from the enrollee or insured
22 at the time the confirmation is provided.
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1 (b) The following balance billing disclosure notice in minimum 12 point
2 typeface:
3 "NOTICE
4 HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A NETWORK
5 HEALTH CARE FACILITY BY FACILITY-BASED PHYSICIANS WHO ARE
6 NOT IN YOUR HEALTH PLAN. YOU MAY BE RESPONSIBLE FOR
7 PAYMENT OF ALL OR PART OF THE FEES FOR THOSE OUT-OF-NETWORK
8 SERVICES, IN ADDITION TO APPLICABLE AMOUNTS DUE FOR
9 CO-PAYMENTS, COINSURANCE, DEDUCTIBLES, AND NON-COVERED
10 SERVICES. SPECIFIC INFORMATION ABOUT IN-NETWORK AND
11 OUT-OF-NETWORK FACILITY-BASED PHYSICIANS CAN BE FOUND AT
12 THE WEBSITE ADDRESS OF YOUR HEALTH PLAN OR BY CALLING THE
13 CUSTOMER SERVICE TELEPHONE NUMBER OF YOUR HEALTH PLAN".
14 Professional services rendered by independent healthcare professionals are
15 not part of the hospital bill. These services will be billed to the patient separately.
16 Please understand that physicians or other healthcare professionals may be called
17 upon to provide care or services to you or on your behalf, but you may not actually
18 see, or be examined by, all physicians or healthcare professionals participating in
19 your care; for example, you may not see physicians providing radiology, pathology,
20 and EKG interpretation. In many instances, there will be a separate charge for
21 professional services rendered by physicians to you or on your behalf, and you will
22 receive a bill for these professional services that is separate from the bill for hospital
23 services. These independent healthcare professionals may not participate in your
24 health plan and you may be responsible for payment of all or part of the fees for the
25 services provided by these physicians who have provided out-of-network services,
26 in addition to applicable amounts due for copayments, coinsurance, deductibles, and
27 non-covered services.
28 We encourage you to contact your health plan to determine whether the
29 independent healthcare professionals are participating with your health plan. In
30 order to obtain the most accurate and up-to-date information about in-network and
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1 out-of-network independent healthcare professionals, please contact the customer
2 service number of your health plan or visit its website. Your health plan is the
3 primary source of information on its provider network and benefits. To help you
4 determine whether the independent healthcare professionals who provide services
5 at this facility are participating with your health plan, this healthcare facility has
6 provided you with a complete list of the names and contact information for each
7 individual or group."
8 (2) Provide a list upon request from an to the enrollee or insured that
9 contains the name and contact information for each individual or group of
10 hospital-contracted anesthesiologists, pathologists, radiologists, hospitalists,
11 intensivists, and neonatologists who provide services at that facility and inform the
12 enrollee or insured that the enrollee or insured may request information from their
13 health insurance issuer as to whether those physicians are contracted with the health
14 insurance issuer and under what circumstances the enrollee or insured may be
15 responsible for payment of any amounts not paid by the health insurance issuer.
16 * * *
17 (4) If a facility meets the definition of a provider-based entity, as defined by
18 42 CFR 413.65, and the facility is located off of the main hospital campus the facility
19 shall disclose to the enrollee or insured the following:
20 (a) That the enrollee or insured is receiving services in a hospital-based
21 outpatient facility where the facility provides the use of the facility, medical, or
22 technical equipment, supplies, staff, and services.
23 (b) That depending on the enrollee's or insured's health insurance benefit
24 plan and the actual services furnished by the facility, the patient may receive a
25 facility charge billed separately from the physician that covers the fees for the use
26 of the facility, medical, or technical equipment, supplies, staff, and services.
27 * * *
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1 E. The provisions of this Section shall be enforced in accordance with R.S.
2 22:1879(D) and (E).
SPEAKER OF THE HOUSE OF REPRESENTATIVES
PRESIDENT OF THE SENATE
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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