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 61 Original 2020 First Extraordinary Session Frieman
Abstract: Prohibits surprise billing by noncontracted, facility-based physicians.
Proposed law defines "surprise billing" as the event in which an enrollee or insured receives any
service at a base healthcare facility that is contracted with his health insurance issuer, but the
facility-based physician providing the service is not contracted with his health insurance issuer and
seeks to collect in excess of the amounts authorized by proposed law.
Present law requires a health insurance issuer to provide a noncontracted, facility-based physician
who renders healthcare services in a base healthcare facility to an enrollee or insured and files a
claim with the health insurance issuer for the facility-based services with an explanation of benefits
as to any payment determination.
Proposed law retains present law but makes technical changes.
Present law (R.S. 22:1875) shall not supersede the provisions of present law (R.S. 22:263(D))
authorizing a healthcare provider who does not contract with a health maintenance organization to
pursue collection from the health maintenance organization for emergency services rendered, if the
healthcare provider has no direct knowledge or information that the patient is an enrollee of a health
maintenance organization.
Proposed law repeals present law.
Proposed law prohibits a facility-based physician providing services at a contracted base healthcare
facility from surprise billing or attempting to collect from an enrollee or insured an amount in excess
of: (1) the amount paid by the issuer to contracted providers for the same or similar services at that
facility, or (2) 135% of the Medicare reimbursement rate for such services, whichever is greater.
Proposed law prohibits the facility-based physician from billing or collecting from an enrollee or
insured amounts other than those representing coinsurance, copayments, deductibles, or other
amounts identified by the health insurance issuer on an explanation of benefits as an amount for
which the enrollee or insured is liable.
Proposed law applies to all services provided by a noncontracted, facility-based provider, regardless
of whether the services were due to an emergency.
(Amends R.S. 22:1875; Adds R.S. 22:1872(24))