§ 22:1873 — Notice requirements

§1873. Notice requirements
A. Provider notice requirements shall be as follows:
(1)(a) Any activity statement received by an enrollee or insured from a contracted
health care provider shall clearly delineate the amount billed to the health insurance issuer
for covered health care services and shall contain the following language conspicuously
displayed on the front of such activity statement in at least twelve-point boldface capital
letters:
THIS IS NOT A BILL. DO NOT PAY. IF IT IS DETERMINED THAT
THIS SERVICE OR A PORTION OF THESE SERVICES IS NOT
PAYABLE BY YOUR HEALTH PLAN, YOU WILL BE RESPONSIBLE."
(b) A provider may revise or update any activity statement to the enrollee or insured
based on the status of the health insurance issuer's liability.
(2) Any bill received by an enrollee or insured from a contracted health care provider
shall clearly delineate the amount that is owed by the enrollee or insured, based on the
contracted reimbursement rate, and shall contain the following language conspicuously
displayed on the front of such bill in at least twelve-point boldface capital letters:
THIS IS A BILL. BASED UPON INFORMATION FROM YOUR HEALTH
PLAN, YOU OWE THE AMOUNT SHOWN."
(3) Any consolidated activity statement and bill received by an enrollee or insured
from a contracted health care provider shall clearly delineate the amount owed by the
enrollee or insured and the amount billed to the health insurance issuer. A consolidated
activity statement and bill shall comply with Paragraph (2) of this Subsection.
(4) In the event that any overstatement in the amount owed by the enrollee or insured
in any bill or in any consolidated activity statement and bill is based on information received
from a health insurance issuer, the contracted health care provider shall not be in violation
of this Subpart.
(5) Any written or electronic notice, publication, or document issued by or on behalf
of a health care facility that identifies any health insurance issuer or network of providers
with which the health care facility is a contracted health care provider shall state that facility-based physicians providing health care services at the facility may not be contracted health
care providers. The facility shall make specific information on contracted or noncontracted
physicians available on request from an enrollee or insured.
B. Health insurance issuer notice requirements shall be as follows:
(1) Each health insurance identification card issued by a health insurance issuer shall
contain sufficient information to clearly identify the health insurance issuer.
(2) Each policy, certificate of insurance, and health insurance identification card
issued by a health insurance issuer shall contain or be accompanied by the following notice
to enrollees or insureds:
YOUR SHARE OF THE PAYMENT FOR HEALTH CARE SERVICES
MAY BE BASED ON THE AGREEMENT BETWEEN YOUR HEALTH
PLAN AND YOUR PROVIDER. UNDER CERTAIN CIRCUMSTANCES,
THIS AGREEMENT MAY ALLOW YOUR PROVIDER TO BILL YOU
FOR AMOUNTS UP TO THE PROVIDER'S REGULAR BILLED
CHARGES."
(3) Any written or electronic notice, publication, or document issued by or on behalf
of a health insurance issuer or through a network of providers to an enrollee or insured that
identifies contracted health care providers shall state that facility-based physicians may not
be contracted health care providers. The health insurance issuer shall make specific
information on contracted and noncontracted facility-based physicians available on request
from an enrollee or insured.
(4) A health insurance issuer shall maintain and update a list of contracted healthcare
providers in accordance with the Network Provider Directory Accessibility and Accuracy
Act, R.S. 22:1020.1 et seq., and shall make the current version available to enrollees or
insureds on request.
(5) In the event that a health insurance issuer determines that any amount due a
health care provider is the responsibility of the enrollee or insured, the health insurance issuer
shall specifically set forth, in its explanation of benefits, the contracted reimbursement rate
and clearly identify the amount due from the enrollee or insured and the reasons therefor.
The health insurance issuer shall determine the responsibility of the enrollee or insured based
on the contracted reimbursement rate.
(6) To the extent that a health insurance issuer determines that additional information
is needed for payment, the health insurance issuer shall notify the health care provider and
the enrollee or insured in writing regarding the information needed and identify the party
responsible for furnishing such information. In the event that the enrollee or insured is the
party responsible for providing such additional information and the enrollee or insured does
not provide the requested information to the health insurance issuer within forty-five days
from the date of such notification, the health care provider may bill the enrollee or insured
for services at the contracted reimbursement rate when a contract exists.
C. If the patient approves in advance and in writing the charges for which the patient
will be responsible, nothing in this Section shall be construed to prevent a dental or vision
patient from choosing any type, form, or quality of procedure that is a noncovered health care
service.

Legislative History

Acts 2003, No. 1157, §1, eff. Jan. 1, 2004; Acts 2004, No. 607, §1; Redesignated from R.S. 22:250.43 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2018, No. 290, §1, eff. Jan. 1, 2019; Acts 2020, No. 315, §1.