2020 Regular Session ENROLLED
SENATE BILL NO. 271
BY SENATOR JOHNS
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., or care services or products excluded
16 from the provisions of this Subpart pursuant to an advance written agreement
17 by the enrollee or insured concerning specific payment terms when authorized
18 by an agreement with the provider under this Paragraph.
19 §1873. Notice requirements
20 * * *
21 C. If the patient approves in advance and in writing the charges for which the
ACT No. 315
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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 ENROLLED
1 patient will be responsible, nothing in this Section shall be construed to prevent a
2 dental or vision patient from choosing any type, form, or quality of dental procedure
3 that is a noncovered health care service.
4 §1874. Billing by contracted healthcare health care providers
5 A. * * *
6 (3) However, in the event that any billing, attempt to collect from, or the
7 collection from an enrollee or insured of any amount other than those representing
8 copayment, deductible, coinsurance, payment for noncovered or noncontracted
9 health care services, or other amounts identified by the health insurance issuer as the
10 liability of the enrollee or insured is based on information received from a health
11 insurance issuer, the contracted health care provider shall not be in violation of this
12 Subsection Subpart.
13 * * *
14 §1878. Exception
15 Regardless of any contractual provisions contained in a health insurance
16 contract or plan delivered in this state, should a patient receive a dental or vision
17 diagnosis from a contracted provider for which the patient qualifies for a covered
18 dental or vision service pursuant to the patient's health plan, the patient may choose
19 either of the following:
20 (1) The covered service designated by the patient's health or, dental, or vision
21 plan for treatment of the condition diagnosed.
22 (2) An alternate type, form, or quality of a dental or vision procedure or
23 product to treat the diagnosed condition which procedure or product is of equal or
24 greater price, provided that the patient approves the alternate procedure or product
25 in advance and in writing. For alternate services, or procedures, or products
26 provided pursuant to this Subsection, the provider shall be paid for the dental or
27 vision procedure or product as follows:
28 (a) The insurer shall pay the amount due for the covered procedure or
29 product which was an approved service or product for the treatment of the
30 diagnosed condition.
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1 (b) The patient shall pay that amount which is the difference between the
2 amount of the covered service or product and the amount of the chosen alternate
3 service, or procedure, or product.
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.