Louisiana Revised Statutes 22:1020.5 – A. If, in any thirty-day period, a health insurance issuer receives three or more reports that allege the issuer’s directory inaccurately represents a healthcare provider’s network p
Terms Used In Louisiana Revised Statutes 22:1020.5
- Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1019.1
- Contract: A legal written agreement that becomes binding when signed.
- Department: means the Department of Insurance. See Louisiana Revised Statutes 22:1020.1
- Health insurance issuer: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a preferred provider organization or any similar entity, or any other entity providing a plan of health insurance or health benefits. See Louisiana Revised Statutes 22:1019.1
- network: means an entity, including a health insurance issuer, that, through contracts or agreements with health care providers, provides or arranges for access by groups of covered persons to health care services by health care providers who are not otherwise or individually contracted directly with a health insurance issuer. See Louisiana Revised Statutes 22:1019.1
- Person: means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination thereof. See Louisiana Revised Statutes 22:1019.1
- provider: means a health care professional or a health care facility. See Louisiana Revised Statutes 22:1019.1
A. If, in any thirty-day period, a health insurance issuer receives three or more reports that allege the issuer’s directory inaccurately represents a healthcare provider‘s network participation status and that are confirmed by the issuer’s investigation, the health insurance issuer shall immediately report that occurrence to the commissioner.
B. On receipt of a report pursuant to Subsection A of this Section, the commissioner shall investigate the health insurance issuer’s compliance with the provisions of this Subpart.
C. The department may collect an assessment in an amount determined by the commissioner from the health insurance issuer at the time of the investigation to cover all expenses attributable directly to the investigation, including but not limited to the salaries and expenses of department employees and all reasonable expenses of the department necessary for the administration of this Subpart.
D. Except as otherwise provided in Subsection F of this Section, the Department of Insurance may promulgate rules and regulations to provide for civil fines payable by a health insurance issuer not to exceed five hundred dollars for each act of violation of the requirements of this Subpart, not to exceed an aggregate fine of fifty thousand dollars. For purposes of this Subsection, “act of violation” is limited to an intentional act or an act of gross negligence.
E.(1) A health insurance issuer shall not be responsible for information that is inaccurately submitted or not submitted by healthcare providers as stated in their contract.
(2) The penalties provided for in this Section shall be the exclusive remedy for any violations and there shall be no independent cause of action by any person based upon a violation or other information reported.
F. The provisions of this Subpart shall apply to the Office of Group Benefits; however, the commissioner of insurance shall not levy an assessment or fine against the Office of Group Benefits. If the commissioner of insurance concludes that the Office of Group Benefits has violated this Subpart, the commissioner of insurance shall notify the commissioner of administration in writing within thirty days of the violation.
Acts 2018, No. 290, §1, eff. Jan. 1, 2019.