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 283 Engrossed 2020 Regular Session Crews
Abstract: Prohibits surprise billing by noncontracted, facility-based physicians.
Proposed law defines "surprise billing" as any bill received by an enrollee or insured for any services
provided at a base healthcare facility that is contracted with the enrollee's or insured's health
insurance issuer but the facility-based physician providing those services is not contracted with the
health insurance issuer and seeks to collect amounts in excess of the amounts authorized by proposed
law.
Present law requires a health insurance issuer to provide a noncontracted, facility-based physician
providing healthcare services in a base healthcare facility to an enrollee or insured, who 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 provides that present law shall not supersede the provisions of present law 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 from surprise billing or attempting to collect from
or collecting from an enrollee or insured an amount in excess of the amount paid by the issuer to
contracted providers for the same or similar services at that facility.
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.
Effective upon signature of governor or lapse of time for gubernatorial action. (Amends R.S. 22:1875; Adds R.S. 22:1872(24)) Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the original bill:
1. Require a facility-based physician at an in-network facility to either contract with the
same insurers as the facility or secure payment from the facility.
2. Remove provisions relative to prohibiting a facility-based physician from being paid in
excess of the median amount paid by the issuer to contracted providers in the parish for
similar services.
3. Make technical changes.