SLS 20RS-509 REENGROSSED
2020 Regular Session
SENATE BILL NO. 271
BY SENATOR JOHNS
HEALTH/ACC INSURANCE. Provides relative to the Health Care Consumer Billing and
Disclosure Protection Act. (8/1/20)
1 AN ACT
2 To amend and reenact R.S. 22:1872(23), 1873(C), 1874(A)(3), and 1878, relative to the
3 Health Care Consumer Billing and Disclosure Protection Act; to provide for
4 definitions; to provide relative to billing by contracted health care providers; and to
5 provide for related matters.
6 Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1872(23), 1873(C), 1874(A)(3), and 1878 are hereby amended
8 and reenacted to read as follows:
9 §1872. Definitions
10 As used in this Subpart:
11 * * *
12 (23) "Noncovered health care services" means services, items, supplies, or
13 drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition,
14 illness, injury, or disease that are neither covered under the terms of health insurance
15 coverage nor required by law to be covered., and care services or products
16 excluded from the provisions of this Subpart pursuant to an advance written
17 agreement by the enrollee or insured concerning specific payment terms when
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 271
SLS 20RS-509 REENGROSSED
1 authorized by an agreement with the provider under this Subpart.
2 §1873. Notice requirements
3 * * *
4 C. If the patient approves in advance and in writing the charges for which the
5 patient will be responsible, nothing in this Section shall be construed to prevent a
6 dental or vision patient from choosing any type, form, or quality of dental procedure
7 that is a noncovered health care service.
8 §1874. Billing by contracted healthcare health care providers
9 A. * * *
10 (3) However, in the event that any billing, attempt to collect from, or the
11 collection from an enrollee or insured of any amount other than those representing
12 copayment, deductible, coinsurance, payment for noncovered or noncontracted
13 health care services, or other amounts identified by the health insurance issuer as the
14 liability of the enrollee or insured is based on information received from a health
15 insurance issuer, the contracted health care provider shall not be in violation of this
16 Subsection Subpart.
17 * * *
18 §1878. Exception
19 Regardless of any contractual provisions contained in a health insurance
20 contract or plan delivered in this state, should a patient receive a dental or vision
21 diagnosis from a contracted provider for which the patient qualifies for a covered
22 dental or vision service pursuant to the patient's health plan, the patient may choose
23 either of the following:
24 (1) The covered service designated by the patient's health or, dental, or vision
25 plan for treatment of the condition diagnosed.
26 (2) An alternate type, form, or quality of a dental or vision procedure or
27 product to treat the diagnosed condition which procedure or product is of equal or
28 greater price, provided that the patient approves the alternate procedure or product
29 in advance and in writing. For alternate services, or procedures, or products
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 271
SLS 20RS-509 REENGROSSED
1 provided pursuant to this Subsection, the provider shall be paid for the dental or
2 vision procedure or product as follows:
3 (a) The insurer shall pay the amount due for the covered procedure or
4 product which was an approved service or product for the treatment of the
5 diagnosed condition.
6 (b) The patient shall pay that amount which is the difference between the
7 amount of the covered service or product and the amount of the chosen alternate
8 service, or procedure, or product.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl B. Cooper.
DIGEST
SB 271 Reengrossed 2020 Regular Session Johns
Present law provides for definitions relative to the Health Care Consumer Billing and
Disclosure Protection Act.
Proposed law retains present law and adds to the definition of "noncovered health care
services" care services or products excluded from the provisions of present law pursuant to
an advance written agreement by the enrollee or insured concerning specific payment terms
when authorized by present law.
Present law provides for exceptions to present law.
Proposed law retains present law and adds vision coverage to a health insurance contract or
plan delivered in this state should a patient receive a diagnosis from a contracted provider
for which the patient qualifies for covered service pursuant to the patient's health plan.
Effective August 1, 2020.
(Amends R.S. 22:1872(23), 1873(C), 1874(A)(3), and 1878)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.