Louisiana § RS 37:1302 - Physician fees; discount to an uninsured individual; effect on a physician's contracted reimbursement amount

§ RS 37:1302. Physician fees; discount to an uninsured individual; effect on a physician's contracted reimbursement amount

A.  Notwithstanding any state or federal provisions to the contrary, a contracted physician licensed to practice medicine by the Louisiana State Board of Medical Examiners may offer a discount for a health care service rendered to an uninsured individual.  Any such discount granted by a contracted physician to an uninsured individual shall not reduce the contracted reimbursement amount between a physician and a health insurance issuer for health care services rendered to the issuer's enrollees and insureds.

B.  For the purposes of this Section:

(1)  "Contracted physician" means a physician licensed to practice medicine by the Louisiana State Board of Medical Examiners who has executed a direct, specific contract with a health insurance issuer.

(2)  "Contracted reimbursement amount" means the quantity of remuneration a health insurance issuer has agreed to pay a physician for rendering health care services in a direct, specific agreement between a physician and a health insurance issuer.

(3)  "Enrollee" or "insured" means an individual who is enrolled or insured by a health insurance issuer for health insurance coverage.

(4)  "Health care service" means one or more services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

(5)  "Health insurance coverage" means benefits consisting of health care services provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as health care services under any medical service policy or certificate, medical service plan contract, preferred provider organization agreement, or health maintenance organization contract.

(6)  "Health insurance issuer" means any entity that offers health insurance coverage through a policy, contract, or certificate of insurance subject to state law that regulates the business of insurance.  For purposes of this Section, a "health insurance issuer" shall include but not be limited to a health maintenance organization as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of Title 22 of the Louisiana Revised Statutes of 1950.  A "health insurance issuer" shall not include any entity preempted as an employee benefit plan under the Employee Retirement Income Security Act of 1974.

Acts 2006, No. 744, §1, eff. June 29, 2006; Acts 2008, No. 415, §2, eff. Jan. 1, 2009.