LSMS Hot Topics

• Balance Billing
• Professional Liability Insurance
• Medicare-Medicaid
• LA Health Care System Reform

Contact Your Representatives

• Find your LA House Representative (by address)
• Find your LA Senator (by address)

General Information

• How a Bill Becomes a Law

The Public Update Legislative Services Line or PULS Line, is available to you by dialing 342-2456 in the Baton Rouge area or toll free (Louisiana only) 800-256-3793 outside Baton Rouge. TTY contact telephone numbers are (225) 219-4688 in Baton Rouge and (888) 850-6489 statewide. Legislative staff will answer your questions about bills on various topics, direct you to the proper place for committee information, explain aspects of the legislative process and more. PULS Line is operated jointly by the House and the Senate with additional staffing and phone lines.

Balance Billing

Consumer Billing: A Hot Topic in the Upcoming Session 3.10.2009 
With the Louisiana Legislature passage of the Health Care Consumer Billing and Disclosure Protection Act of 2003, the issue of consumer billing seemed to be settled. Effective January 1, 2004, this law addressed the issue of “balanced billing,” a practice in which healthcare providers bill for the balance of a bill for care rendered by the provider and not paid for by insurer health benefits. Under the 2003 law, detailed provisions prohibited, in most cases, the act of balanced billing by healthcare providers. The law also set forth specific language that must be included on patient bills generated by both providers and insurers, and outlines the process for registering complaints and for levying penalties. Recently, Insurance Commissioner James J. Donelon has asked for the law to be reviewed in the 2009 Regular Legislative Session because some patients have expressed objections about the billing process. The LSMS believes the current law adequately meets the needs of patients and providers, and will monitor this issue over the coming months. For your information, a summary of the current law follows.  

A Review of the Current Law
Contracted healthcare providers are required to clearly delineate the amount billed to the health insurance issuer and the amount owed by the enrollee or insured; as well as include certain language on activity statements and bills. Contracted healthcare providers are prohibited from attempting to collect, or from collecting, from an insured or enrollee any amount that is: in excess of the contracted reimbursement rate for covered healthcare services (“discount billing”); a health insurance issuer liability (“dual billing”); or, any amount other than coinsurance, co-payments, deductibles, payment for non-covered or non-contracted healthcare services, or any other amount identified by the health insurance issuer on an Explanation of Benefits (EOB) as the liability of the health insurance issuer.

Please note that if any of the above occur based on information received from the insurer, the provider shall not be in violation. Contracted healthcare providers are prohibited from maintaining any legal action against an insured or enrollee for a health insurance issuer liability or for payment of any amount in excess of the contracted reimbursement rate; in the event of such an action, the prevailing party may recover all costs incurred. The law does not affect non-contracted physicians, with one exception: If a non-contracted, facility-based physician provides health care services in a base healthcare facility to an insured or enrollee, and files a claim for those services, the health insurance issuer must then provide the facility based physician with an EOB as to any payment determination. Health plans are subject to fines of up to $5,000 per violation. Providers may face fines of up to $1,000 per claim or violation.

Patient Friendly Billing: A Guide to Understanding Provider Responsibilities Under Louisiana's Health Care Consumer Billing and Disclosure Protection Act of 2003, is a detailed brochure that provides a review of the law and guidance to healthcare providers in complying with current laws. The information was compiled through the cooperative efforts of the members of the Louisiana Managed Care Coalition: Louisiana Hospital Association, Louisiana Medical Group Managers Association, and Louisiana State Medical Society.

Professional Liability Insurance