Balance billing disclosure
A. Definitions.— As used in this Section, the following terms shall be defined as follows:
(1) “Balance billing” means any written or electronic communication by a non-contracted health care provider that appears to attempt to collect from an enrollee or insured any amount for covered, non-covered, and out-of-network health care services received by the enrollee or insured from the non-contracted health care provider that is not fully paid by the enrollee or insured, or the health insurance issuer.
(2) “Enrollee or insured liability” means the financial liability of an enrollee or insured for covered, non-covered, and out-of-network health care services pursuant to the plan or policy provisions between the enrollee or insured and the health insurance issuer.
(a) In the case of a contracted health care provider, “enrollee or insured liability” is the amount due for coinsurance, co-payments, deductibles, non-covered services, or any other amounts identified by the health insurance issuer on an explanation of benefits as an amount for which the enrollee or insured is liable for the covered or non-covered service.
(b) In the case of a non-contracted health care provider, “enrollee or insured liability” is the amount as determined pursuant to the plan or policy provisions between the enrollee or insured and the health insurance issuer for covered and non-covered, out-of-network health care services, including but not limited to the enrollee’s or insured’s contractual deductible, coinsurance, or co-payment amount.
B.(1) Health insurance issuer disclosure requirements. — Each health insurance issuer shall provide the following balance billing disclosure notice:
HEALTH CARE SERVICES MAY BE PROVIDED TO YOU AT A NETWORK HEALTH CARE FACILITY BY FACILITY-BASED PHYSICIANS WHO ARE NOT IN YOUR HEALTH PLAN. YOU MAY BE RESPONSIBLE FOR PAYMENT OF ALL OR PART OF THE FEES FOR THOSE OUT-OF-NETWORK SERVICES, IN ADDITION TO APPLICABLE AMOUNTS DUE FOR CO-PAYMENTS, COINSURANCE, DEDUCTIBLES, AND NON-COVERED SERVICES.
SPECIFIC INFORMATION ABOUT IN-NETWORK AND OUT-OF- NETWORK FACILITY-BASED PHYSICIANS CAN BE FOUND AT THE WEBSITE ADDRESS OF YOUR HEALTH PLAN OR BY CALLING THE CUSTOMER SERVICE TELEPHONE NUMBER OF YOUR HEALTH PLAN”.
(2) The balance billing disclosure notice shall be disclosed in all of the following methods:
(a) To the potential policyholder prior to the time the health benefit plan is purchased. The disclosure notice may be provided directly by the health insurance issuer or through an authorized insurance producer. If the health insurance issuer provides the disclosure notice to the producer, then the producer shall provide that disclosure notice to the potential policyholder.
(b) To the policyholder and enrollees, at the time the insurance policy or other proof of coverage is issued, as follows:
(i) For a group benefit plan, to the policyholder and employees at the time the insurance policy or other proof of insurance coverage is issued.
(ii) For an individual benefit plan, to the policyholder at the time the insurance policy or other proof of insurance coverage is issued.
(c) To the policyholder and enrollees at least once a year as follows:
(i) For a group benefit plan, to the policyholder and employees.
(ii) For an individual benefit plan, to the policyholder.
(d) On the health insurance issuer’s website.
C. Facility disclosure requirements. — Facility disclosure requirements. Each healthcare facility shall do all of the following:
(1) Provide a written notice regarding nonemergency services to a patient whenever a healthcare facility provides a notice of privacy practices pursuant to 45 CFR 164.520 to a patient for whom the healthcare facility has knowledge that a contract with a health insurance issuer is effective or upon the request of the patient. The written notice shall be signed by the patient and disclose both of the following items:
(a) Confirmation as to whether the facility is a participating provider contracted with the enrollee’s or insured’s health insurance issuer on the date services are to be rendered, based on the information received from the enrollee or insured at the time the confirmation is provided.
(b) The following balance billing disclosure notice in minimum 12 point typeface:
Professional services rendered by independent healthcare professionals are not part of the hospital bill. These services will be billed to the patient separately. Please understand that physicians or other healthcare professionals may be called upon to provide care or services to you or on your behalf, but you may not actually see, or be examined by, all physicians or healthcare professionals participating in your care; for example, you may not see physicians providing radiology, pathology, and EKG interpretation. In many instances, there will be a separate charge for professional services rendered by physicians to you or on your behalf, and you will receive a bill for these professional services that is separate from the bill for hospital services. These independent healthcare professionals may not participate in your health plan and you may be responsible for payment of all or part of the fees for the services provided by these physicians who have provided out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles, and non-covered services.
We encourage you to contact your health plan to determine whether the independent healthcare professionals are participating with your health plan. In order to obtain the most accurate and up-to-date information about in-network and out-of-network independent healthcare professionals, please contact the customer service number of your health plan or visit its website. Your health plan is the primary source of information on its provider network and benefits. To help you determine whether the independent healthcare professionals who provide services at this facility are participating with your health plan, this healthcare facility has provided you with a complete list of the names and contact information for each individual or group.
(2) Provide a list to the enrollee or insured that contains the name and contact information for each individual or group of hospital-contracted anesthesiologists, pathologists, radiologists, hospitalists, intensivists, and neonatologists who provide services at that facility and inform the enrollee or insured that the enrollee or insured may request information from their health insurance issuer as to whether those physicians are contracted with the health insurance issuer and under what circumstances the enrollee or insured may be responsible for payment of any amounts not paid by the health insurance issuer.
(3) If the facility operates a website that includes a listing of physicians who have been granted medical staff privileges to provide medical services at the facility, post on the facility’s website a list that contains the name and contact information for each facility-based physician or facility-based physician group that has been granted medical staff privileges to provide medical services at the facility, and an update of the list within thirty days of any changes.
(4) [Repealed by Acts 2018, No. 288, § 2, effective May 18, 2018.]
D. Facility-based physician disclosure requirements. — Whenever a facility-based physician bills a patient who has health insurance coverage issued by a health insurance issuer that does not have a contract with the facility-based physician, the facility-based physician shall send a bill that includes all of the following items:
(1) An itemized listing of the services and supplies provided by the facility-based physician along with the dates such services and supplies were provided.
(2) The amount that is owed by the enrollee or insured and language conspicuously displayed on the front of such bill:
“NOTICE: THIS IS A BILL. BASED UPON INFORMATION FROM YOUR HEALTH PLAN, YOU OWE THE AMOUNT SHOWN”.
(3) A telephone number to call to discuss the statement.
E. The provisions of this Section shall be enforced in accordance with R.S. 22:1879(D) and (E).