Louisiana Revised Statutes 40:2203 – A. Any group purchaser may contract with any provider in any contractual agreement or agreements to form a preferred provider organization.
Terms Used In Louisiana Revised Statutes 40:2203
- Contract: A legal written agreement that becomes binding when signed.
- Governmental body: means any department, commission, council, board, office, bureau, committee, institution, agency, government, corporation, or establishment of the executive branch of this state. See Louisiana Revised Statutes 40:2202
- Group purchaser: shall mean an organization or entity which contracts with providers for the purpose of establishing a preferred provider organization. See Louisiana Revised Statutes 40:2202
- person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
- Provider: shall mean one or more entities which offer health care services and shall include but not be limited to hospitals, individuals, or groups of physicians, individuals or groups of psychologists, nurse midwives, ambulance service companies, and other health care entities. See Louisiana Revised Statutes 40:2202
A. Any group purchaser may contract with any provider in any contractual agreement or agreements to form a preferred provider organization.
B. Such agreement shall not be construed to authorize a group purchaser to furnish medical services unless the purchaser is otherwise licensed to do so, nor shall such agreement authorize a group purchaser to direct or control the provision or selection of forms or types of medical services to the group members.
C. Group purchaser members participating in preferred provider organizations shall be guaranteed access to their standard benefits under the terms of their policy, employee benefits, self-funded organization benefits, or Taft-Hartley trust benefits, regardless of whether they choose a preferred provider or a provider who does not participate in the preferred provider contract.
D. Any entity serving as a broker or intermediary under the provisions of La. Rev. Stat. 40:2202(3)(b) who contracts to write or sell insurance shall be subject to the provisions of Title 22 of the Louisiana Revised Statutes of 1950. However, any entity which serves as a broker or intermediary for the formation of a preferred provider organization for a governmental body shall not be entitled to collect any fee for serving as such broker or intermediary under this Part.
E. Any person requiring emergency medical services shall be entitled to use any available provider without being denied the basic benefits provided under his policy or benefits program.
Added by Acts 1984, No. 374, §1, eff. July 6, 1984; Acts 2018, No. 206, §4.