Louisiana Revised Statutes 22:2401 – Health insurance issuers shall implement effective processes for appeals of coverage determinations and claims. The processes shall comply with any applicable federal law or regulati
Terms Used In Louisiana Revised Statutes 22:2401
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- benefits: means those health care services to which a covered person is entitled under the terms of a health benefit plan. See Louisiana Revised Statutes 22:2392
- 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 to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including through a health benefit plan as defined in this Section, and shall include 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 22:2392
Health insurance issuers shall implement effective processes for appeals of coverage determinations and claims. The processes shall comply with any applicable federal law or regulation. Under such processes, a health insurance issuer shall, at a minimum:
(1) Have in effect an internal claims appeal process.
(2) Provide notice to covered persons, in a culturally and linguistically appropriate manner, of available internal and external appeals processes and the availability of the office of consumer advocacy of the Department of Insurance to assist such persons with the appeals process.
(3) Allow covered persons, upon request and free of charge, to review and have copies of all documents relevant to the claim for benefits and to submit comments and documents relating to the claim, without regard to whether that information was submitted or considered in the initial benefit determination, and to receive continued coverage pending the outcome of the appeals process where required by applicable law or the plan document or policy.
Acts 2013, No. 326, §1, eff. Jan. 1, 2015; Acts 2020, No. 36, §1.