§ 22:1878 — Exception

§1878. Exception
Regardless of any contractual provisions contained in a health insurance contract or
plan delivered in this state, should a patient receive a dental or vision diagnosis from a
contracted provider for which the patient qualifies for a covered dental or vision service
pursuant to the patient's health plan, the patient may choose either of the following:
(1) The covered service designated by the patient's health, dental, or vision plan for
treatment of the condition diagnosed.
(2) An alternate type, form, or quality of a dental or vision procedure or product to
treat the diagnosed condition which procedure or product is of equal or greater price,
provided that the patient approves the alternate procedure or product in advance and in
writing. For alternate services, procedures, or products provided pursuant to this Subsection,
the provider shall be paid for the dental or vision procedure or product as follows:
(a) The insurer shall pay the amount due for the covered procedure or product which
was an approved service or product for the treatment of the diagnosed condition.
(b) The patient shall pay that amount which is the difference between the amount of
the covered service or product and the amount of the chosen alternate service, procedure, or
product.

Legislative History

Acts 2004, No. 607, §1; Redesignated from R.S. 22:250.48 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2020, No. 315, §1.