Terms Used In Louisiana Revised Statutes > Title 22 > Chapter 6 > Part II > Subpart D - Health Care Consumer Billing and Disclosure Protection Act

• Activity statement: means any written communication from a health care provider that advises an enrollee or insured of covered health care services that have been billed to a health insurance issuer. See Louisiana Revised Statutes 22:1872
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Appraisal: A determination of property value.
• Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
• Base health care facility: means a facility or institution providing health care services, including but not limited to a hospital or other licensed inpatient center, ambulatory surgical or treatment center, skilled nursing facility, inpatient hospice facility, residential treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting that has entered into a contract or agreement with a facility-based physician. See Louisiana Revised Statutes 22:1872
• Bill: means any written or electronic communication that sets forth the amount owed by an enrollee or insured. See Louisiana Revised Statutes 22:1872
• Child: means a person who has not reached age eighteen or otherwise been legally emancipated. See Louisiana Revised Statutes 17:407.33
• Child day care center: means any place or facility operated by any institution, political subdivision, society, agency, corporation, person or persons, or any other group for the purpose of providing care, supervision, and guidance of seven or more children, not including those related to the caregiver, unaccompanied by parent or legal custodian, on a regular basis for at least twelve and one-half hours in a continuous seven-day week. See Louisiana Revised Statutes 17:407.33
• Commissioner: means the commissioner of insurance. See Louisiana Revised Statutes 22:1872
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Consolidated activity statement and bill: means any written or electronic communication from a health care provider that advises an enrollee or insured of covered health care services that have been billed to a health insurance issuer and which sets forth an amount owed by an enrollee or insured. See Louisiana Revised Statutes 22:1872
• Contract: A legal written agreement that becomes binding when signed.
• Contracted health care provider: means a health care provider that has entered into a contract or agreement directly with a health insurance issuer or with a health insurance issuer through a network of providers for the provision of covered health care services. See Louisiana Revised Statutes 22:1872
• Contracted reimbursement rate: means the aggregate maximum amount that a contracted health care provider has agreed to accept from all sources for provision of covered health care services under the health insurance coverage applicable to the enrollee or insured. See Louisiana Revised Statutes 22:1872
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Covered health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease that are either covered and payable under the terms of health insurance coverage or required by law to be covered. See Louisiana Revised Statutes 22:1872
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Department: means the state Department of Education. See Louisiana Revised Statutes 17:407.33
• Dependent: A person dependent for support upon another.
• Discount billing: means any written or electronic communication issued by a contracted health care provider that appears to attempt to collect from an enrollee or insured an amount in excess of the contracted reimbursement rate for covered services. See Louisiana Revised Statutes 22:1872
• Dual billing: means any written or electronic communication issued by a contracted health care provider that sets forth any amount owed by an enrollee or insured that is a health insurance issuer liability. See Louisiana Revised Statutes 22:1872
• Early learning center: means any child day care center, Early Head Start Center, Head Start Center, or stand-alone prekindergarten program not attached to a school. See Louisiana Revised Statutes 17:407.33
• Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. ^{Source: U.S. Courts}
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Ex officio: Literally, by virtue of one's office.
• Explanation of benefits: means any written communication clearly identified as issued by the health insurance issuer or its agent that contains information regarding coverage, payment, or other information regarding current status of a claim submitted to the health insurance issuer or its agent. See Louisiana Revised Statutes 22:1872
• Facility-based physician: means a physician licensed to practice medicine who is required by the base health facility to provide services in a base health care facility as an anesthesiologist, hospitalist, intensivist, neonatologist, pathologist, radiologist, emergency room physician, or other on-call physician who is required by the base health care to provide covered health care services related to an emergency medical condition as defined in La. See Louisiana Revised Statutes 22:1872
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• Fraud: Intentional deception resulting in injury to another.
• Grantor: The person who establishes a trust and places property into it.
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health care facility: means a facility or institution providing health care services including but not limited to a hospital or other licensed inpatient center, ambulatory surgical or treatment center, skilled nursing facility, inpatient hospice facility, residential treatment center, diagnostic, laboratory, or imaging center, or rehabilitation or other therapeutic health setting. See Louisiana Revised Statutes 22:1872
• Health care professional: means a physician or other health care practitioner licensed, certified, or registered to perform specified health care services consistent with state law. See Louisiana Revised Statutes 22:1872
• Health care services: means services, items, supplies, or drugs for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease. See Louisiana Revised Statutes 22:1872
• Health insurance coverage: means benefits consisting of medical care provided or arranged for directly, through insurance or reimbursement, or otherwise, and includes health care services paid for under any plan, policy, or certificate of insurance. See Louisiana Revised Statutes 22:1872
• Health insurance issuer: means any entity that offers health insurance coverage through a policy or certificate of insurance subject to state law that regulates the business of insurance. See Louisiana Revised Statutes 22:1872
• Health insurance issuer liability: means the contractual liability of a health insurance issuer for covered health care services pursuant to the plan or policy provisions between the enrollee or insured and the health insurance issuer. See Louisiana Revised Statutes 22:1872
• insured: means a person who is enrolled in or insured by a health insurance issuer for health insurance coverage. See Louisiana Revised Statutes 22:1872
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). ^{Source: OCC}
• Legatee: A beneficiary of a decedent
• Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
• network: means an entity other than a health insurance issuer that, through contracts with health care providers, provides or arranges for access by groups of enrollees or insureds 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 22:1872
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Original bill: A bill which is drafted by a committee. It is introduced by the committee or subcommittee chairman after the committee votes to report it.
• person: includes a body of persons, whether incorporated or not. See Louisiana Revised Statutes 1:10
• provider: means a health care professional or a health care facility or the agent or assignee of such professional or facility. See Louisiana Revised Statutes 22:1872
• Quorum: The number of legislators that must be present to do business.
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• Statute: A law passed by a legislature.