HLS 20RS-748 ENGROSSED
2020 Regular Session
HOUSE BILL NO. 283
BY REPRESENTATIVES CREWS, ADAMS, DUBUISSON, EDMONSTON, FREIBERG,
HORTON, NEWELL, ROBERT OWEN, CHARLES OWEN, AND THOMAS
INSURANCE/HEALTH: Provides relative to billing by noncontracted facility-based
physicians
1 AN ACT
2To amend and reenact R.S. 22:1875 and to enact R.S. 22:1872(24), relative to billing by
3 noncontracted facility-based physicians; to define surprise billing; to prohibit
4 surprise billing; to provide for billing by noncontracted facility-based providers; to
5 provide for applicability; to provide for an effective date; and to provide for related
6 matters.
7Be it enacted by the Legislature of Louisiana:
8 Section 1. R.S. 22:1875 is hereby amended and reenacted and R.S. 22:1872(24) is
9hereby enacted to read as follows:
10 §1872. Definitions
11 As used in this Subpart:
12 * * *
13 (24) "Surprise billing" means any bill received by an enrollee or insured for
14 any services provided at a base healthcare facility that is contracted with the
15 enrollee's or insured's health insurance issuer but the facility-based physician
16 providing those services is not contracted with the health insurance issuer and seeks
17 to collect amounts in excess of the amounts authorized by R.S. 22:1875.
18 * * *
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HB NO. 283
1 §1875. Billing by noncontracted facility-based physicians providing services in a
2 base health care healthcare facility
3 A. If a facility-based physician who is a noncontracted health care healthcare
4 provider provides health care healthcare services in a base health care healthcare
5 facility to an enrollee or insured and files a claim with a health insurance issuer for
6 such the facility-based services, the health insurance issuer shall provide the facility-
7 based physician with an explanation of benefits as to any payment determination
8 thereof. Nothing contained in this Subpart shall supercede the provisions of R.S.
9 22:263(D).
10 B. For purposes of this Section, a facility-based physician at an in-network
11 facility shall do either of the following:
12 (1) Contract with the same insurers as the facility.
13 (2) Secure payment from the facility.
14 C. The facility-based physician shall be prohibited from surprise billing or
15 attempting to collect from or collecting from an enrollee or insured an amount in
16 excess of the amount paid by the health insurance issuer to contracted providers for
17 the same or similar services at that facility.
18 D. The facility-based physician shall not bill, attempt to collect from, or
19 collect from an enrollee or insured amounts other than those representing
20 coinsurance, copayments, deductibles, or other amounts identified by the health
21 insurance issuer on an explanation of benefits as an amount for which the enrollee
22 or insured is liable.
23 E. The provisions of this Section shall apply to all services provided by a
24 noncontracted, facility-based provider, regardless of whether the services were due
25 to an emergency.
26 Section 2. This Act shall become effective upon signature by the governor or, if not
27signed by the governor, upon expiration of the time for bills to become law without signature
28by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
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HB NO. 283
1vetoed by the governor and subsequently approved by the legislature, this Act shall become
2effective on the day following such approval.
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))
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HB NO. 283
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.
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