SLSX 25RS-421 ORIGINAL
2025 Regular Session
SENATE BILL NO. 230
BY SENATOR KLEINPETER
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
HEALTH/ACC INSURANCE. Provides relative to recovery of past medical expenses.
(1/1/26)
1 AN ACT
2 To enact R.S. 22:1839, relative to the payment of health care expenses; to provide for limits
3 of payment and of recovery; to provide for exceptions; to provide for prospective
4 application; to provide an effective date; and to provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1839 is hereby enacted to read as follows:
7 ยง1839. Healthcare expenses; payments
8 A. Notwithstanding any provision of R.S. 22:1831 to the contrary, for the
9 purpose of this Section the following definitions apply:
10 (1) "Health insurance coverage" means benefits consisting of health care
11 services provided through insurance, reimbursement, or otherwise which
12 includes items and services paid for as health care services under any hospital
13 or medical service policy or certificate, hospital or medical service plan
14 contract, preferred provider organization agreement, or health maintenance
15 organization contract offered by a private health issuer, the Office of Group
16 Benefits, Medicare, Medicaid, Louisiana Workers' Compensation Law or
17 equivalent state health plans.
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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. 230
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1 (2) "Usual and customary rate" means one hundred twenty percent of
2 the applicable Medicare reimbursement rate in effect on the date of the health
3 care services, or, if there is no applicable Medicare rate for a service, one
4 hundred seventy percent of the applicable state Medicaid rate. If there is no
5 applicable Medicare or Medicaid rate for a service, "usual and customary rate"
6 means the average amount accepted by medical providers in the area for the
7 service.
8 B. Notwithstanding the provisions of R.S. 22:1832(D) and 1833(E), the
9 payment of electronic and nonelectronic claims for past health care service
10 expenses, if paid through health insurance coverage, pursuant to R.S. 22:1832,
11 1833, 1853, or 1854, shall be limited to the health issuer's liability.
12 C. The recovery of past health care service expenses, other than those
13 provided for in Subsection B of this Section, shall be limited to the lesser of the
14 following:
15 (1) The amount actually paid to a health care provider by or on behalf
16 of the claimant, regardless of the source of the payment.
17 (2) The usual and customary rate.
18 D. This Section shall not apply in cases brought pursuant to R.S.
19 40:1231.1 et seq., or 1237.1 et seq.
20 Section 2. The provisions of this Act shall become effective on January 1, 2026.
21 Section 3. The provisions of this Act shall have prospective application only and
22 shall not apply to causes of action filed prior to the effective date of this Act.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Senate Legislative Services.
The keyword, summary, 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)]
DIGEST
SB 230 Original 2025 Regular Session Kleinpeter
Proposed law defines "health insurance coverage" and "usual and customary rate".
Proposed law provides that the payment of claims for past health care service expenses, if
paid through health insurance coverage, shall be limited to the health issuer's liability. Also
provides that the recovery of past health care service expenses are limited to the lesser of the
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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. 230
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amount actually paid to a health care provider by or on behalf of the claimant, regardless of
the source of the payment or the usual and customary rate.
Proposed law provides that proposed law shall not apply in certain cases brought pursuant
to present law. (Medical Malpractice and Malpractice Liability for State Services)
Proposed law provides that the provisions of proposed law shall have prospective application
only and shall not apply to causes of action filed prior to the effective date of proposed law.
Effective on January 1, 2026.
(Adds R.S. 22:1839)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.