Title 22, Insurance
0 chapters · 2,651 sections in this title.
La. Rev. Stat. § 22:1845.1 Telehealth coverage and reimbursement for physical therapy; prohibitions and
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§1845.1. Telehealth coverage and reimbursement for physical therapy; prohibitions and limitations; exceptions; rulemaking A. A health coverage plan shall pay for covered physical therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall …
La. Rev. Stat. § 22:1845.2 Telehealth coverage and reimbursement for occupational therapy; prohibitions and
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§1845.2. Telehealth coverage and reimbursement for occupational therapy; prohibitions and limitations; exceptions; rulemaking A. A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and paymen…
La. Rev. Stat. § 22:185 Application of other sections
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§185. Application of other sections Except as otherwise provided in this Subpart, every reciprocal insurer shall be subject to other applicable provisions of this Code. Acts 1958, No. 125; Redesignated from R.S. 22:456 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1851 Legislative intent
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§1851. Legislative intent The legislature finds that making prompt and correct payment for prescription drugs, other products and supplies, and pharmacist services covered under insurance or other contracts that provide for pharmacy benefits is important to the health and welfare…
La. Rev. Stat. § 22:1852 Definitions
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§1852. Definitions As used in this Subpart, the following terms are defined as follows: (1) "Claim" means a request by a pharmacist for payment by a health insurance issuer. (2) "Commissioner" means the commissioner of insurance. (3) "Department" means the Department of Insurance…
La. Rev. Stat. § 22:1853 Nonelectronic claims submission
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§1853. Nonelectronic claims submission A.(1) Any nonelectronic claim for payment for prescription drugs, other products and supplies, and pharmacist services submitted by a pharmacist or pharmacy within forty-five days of the date of service under a contract for provision of cove…
La. Rev. Stat. § 22:1854 Electronic claim submission standards
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§1854. Electronic claim submission standards A. Any claim for payment for covered prescription drugs, other products and supplies, and pharmacist services submitted by a pharmacist or pharmacy to a health insurance issuer as an electronic claim that is electronically adjudicated …
La. Rev. Stat. § 22:1855 Submission to health insurance issuer
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§1855. Submission to health insurance issuer A. For purposes of R.S. 22:1853, a claim shall be deemed to be submitted to the health insurance issuer when a nonelectronic claim is furnished to the health insurance issuer, its agent, or any other party that makes payment directly t…
La. Rev. Stat. § 22:1856 Payment standard; limitations on claim filing and audits; remittance advice
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§1856. Payment standard; limitations on claim filing and audits; remittance advice A. A health insurance issuer may elect to utilize a thirty-day payment standard for compliance with R.S. 22:1853 by providing written notice to the commissioner. Such notice shall be in a form pres…
La. Rev. Stat. § 22:1856.1 Pharmacy record audits; recoupment; appeals
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§1856.1. Pharmacy record audits; recoupment; appeals A. As used in this Section, "entity" means a managed care company, insurance company, third-party payor, or the representative of the managed care company including a pharmacy benefit manager, insurance company, or third-party …
La. Rev. Stat. § 22:1857 Prescription drugs, products, and supplies; use of index
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§1857. Prescription drugs, products, and supplies; use of index A. Reimbursement under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricin…
La. Rev. Stat. § 22:1857.1 Third-party contracts with pharmacies
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§1857.1. Third-party contracts with pharmacies A. Notwithstanding any provision of law to the contrary, an organization that negotiates with a pharmacy or pharmacies, and an organization that represents an independent pharmacy or a group of independent pharmacies, shall provide t…
La. Rev. Stat. § 22:1858 Coordination of benefits
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§1858. Coordination of benefits A. Coordination of benefit requirements adopted by health insurance issuers shall, at a minimum, adhere to the following requirements: (1) No plan shall contain a provision that its benefits are "always excess" or "always secondary" except in accor…
La. Rev. Stat. § 22:1859 Recoupment of health insurance claims payments
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§1859. Recoupment of health insurance claims payments A. As used in this Section, "recoupment" shall mean a reduction, offset, adjustment, or other act to lower or lessen the payment of a claim or any other amount owed to a pharmacy or pharmacist for any reason unrelated to that …
La. Rev. Stat. § 22:1860 Violations; cease and desist orders; penalties
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§1860. Violations; cease and desist orders; penalties A. Whenever the commissioner has reason to believe that any health insurance issuer is not in full compliance with the requirements of this Subpart, the commissioner shall notify such issuer in accordance and compliance with R…
La. Rev. Stat. § 22:1860.1 Reimbursement of pharmacy provider fee; sanctions; administrative hearings
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§1860.1. Reimbursement of pharmacy provider fee; sanctions; administrative hearings A. It is the obligation of a health insurance issuer or its agent to reimburse a pharmacist or his agent for fees remitted by a pharmacy or pharmacist or his agent in compliance with R.S. 46:2625.…
La. Rev. Stat. § 22:1860.2 Repealed by Acts 2025, No
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§1860.2. Repealed by Acts 2025, No. 474, §4, eff. June 20, 2025.
La. Rev. Stat. § 22:1860.3 Reimbursements
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§1860.3. Reimbursements A. A pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager shall not reimburse a pharmacy or pharmacist in this state an amount less than the amount that the pharmacy benefit manager reimburses an affiliate of the pharmacy benef…
La. Rev. Stat. § 22:1861 Regulations
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§1861. Regulations The commissioner may promulgate such rules and regulations as may be necessary or proper to carry out the provisions of this Subpart. Such rules and regulations shall be promulgated and adopted in accordance with the Administrative Procedure Act. Acts 2004, No.…
La. Rev. Stat. § 22:1862 Applicability
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§1862. Applicability The provisions of Subpart B of Part II of this Chapter, R.S. 22:1831 et seq., shall not apply to this Subpart. Acts 2004, No. 876, §1, eff. Jan. 1, 2005; Redesignated from R.S. 22:250.62 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1863 Definitions
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§1863. Definitions As used in this Subpart, the following definitions apply: (1) "Drug Shortage List" means a list of drug products posted on the United States Food and Drug Administration drug shortage website. (2) "Effective rate pricing" means any payment reduction for pharmac…
La. Rev. Stat. § 22:1864 Requirements for use of the National Drug Code by a pharmacy benefit manager
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§1864. Requirements for use of the National Drug Code by a pharmacy benefit manager A. Before a pharmacy benefit manager places or continues a particular NDC or Maximum Allowable Cost List, the following requirements shall be met: (1) The prescription drug to which the NDC is ass…
La. Rev. Stat. § 22:1865 Appeals; maximum allowable costs
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§1865. Appeals; maximum allowable costs A. The pharmacy benefit manager shall provide a reasonable administrative appeal procedure to allow pharmacies to challenge maximum allowable costs for a specific NDC or NDCs as not meeting the requirements of this Subpart or being below th…
La. Rev. Stat. § 22:1866 Rulemaking authority; administrative appeals
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§1866. Rulemaking authority; administrative appeals A. The commissioner may promulgate rules and regulations in accordance with the Administrative Procedure Act that are necessary or proper to carry out the provisions of this Subpart. B. Any pharmacy benefit manager, insurer, or …
La. Rev. Stat. § 22:1867 Prohibition on spread pricing; effective rate pricing; fees
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§1867. Prohibition on spread pricing; effective rate pricing; fees A. A pharmacy benefit manager is prohibited from conducting or participating in spread pricing in this state. B. A pharmacy benefit manager is prohibited from using effective rate pricing for a local pharmacy. C. …
La. Rev. Stat. § 22:1868 Local pharmacy reimbursement; National Average Drug Acquisition Costs; appeals
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§1868. Local pharmacy reimbursement; National Average Drug Acquisition Costs; appeals A. No pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager shall reimburse a pharmacy or pharmacist in this state an amount less than the acquisition cost for the co…
La. Rev. Stat. § 22:1868.1 Pharmacy benefit manager rebate retention restrictions; fee disclosure
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§1868.1. Pharmacy benefit manager rebate retention restrictions; fee disclosure A. A pharmacy benefit manager may negotiate, but shall not retain any portion of rebates received from a drug manufacturer. All manufacturer rebates shall be passed through to the plan sponsor as shar…
La. Rev. Stat. § 22:1869 Compensation program; review by commissioner; exceptions
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§1869. Compensation program; review by commissioner; exceptions A. The commissioner may review the compensation program of a pharmacy benefit manager or person acting on behalf of a pharmacy benefit manager with a health insurance issuer, pharmacy services administrative organiza…
La. Rev. Stat. § 22:1870 Pharmacy benefit manager transparency report; examination by commissioner
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§1870. Pharmacy benefit manager transparency report; examination by commissioner A. Each pharmacy benefit manager licensed by the commissioner shall submit an annual transparency report as a condition of maintaining licensure. B.(1) On March first of each year, each licensed phar…
La. Rev. Stat. § 22:1870.1 Enforcement; Pharmacy Benefit Manager Enforcement Fund; creation
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§1870.1. Enforcement; Pharmacy Benefit Manager Enforcement Fund; creation A. The commissioner shall enforce the provisions of this Section with all of the powers and authority vested in him pursuant to this Title. B. Any act or combination of acts prohibited by this Section shall…
La. Rev. Stat. § 22:1871 Short title
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§1871. Short title This Subpart shall be known and may be cited as the "Health Care Consumer Billing and Disclosure Protection Act". Acts 2003, No. 1157, §1, eff. Jan. 1, 2004; Redesignated from R.S. 22:250.41 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
La. Rev. Stat. § 22:1872 Definitions
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§1872. Definitions As used in this Subpart: (1) "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. (2) "Base health care facility"…
La. Rev. Stat. § 22:1873 Notice requirements
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§1873. Notice requirements A. Provider notice requirements shall be as follows: (1)(a) Any activity statement received by an enrollee or insured from a contracted health care provider shall clearly delineate the amount billed to the health insurance issuer for covered health care…
La. Rev. Stat. § 22:1874 Billing by contracted healthcare providers
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§1874. Billing by contracted healthcare providers A.(1) A contracted health care provider shall be prohibited from discount billing, dual billing, attempting to collect from, or collecting from an enrollee or insured a health insurance issuer liability or any amount in excess of …
La. Rev. Stat. § 22:1875 Billing by noncontracted facility-based physicians providing services in a base health care facility
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§1875. Billing by noncontracted facility-based physicians providing services in a base health care facility If a facility-based physician who is a noncontracted health care provider provides health care services in a base health care facility to an enrollee or insured and files a…
La. Rev. Stat. § 22:1876 Correction of credit records
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§1876. Correction of credit records Any contracted health care provider who files, refers, or sends a report to a credit reporting agency for nonpayment by an enrollee or insured of any amount that he is prohibited by R.S. 22:1874(A) from billing or collecting shall assist in cor…
La. Rev. Stat. § 22:1877 Complaint notice; billing correction and refund; penalty
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§1877. Complaint notice; billing correction and refund; penalty A.(1) Any enrollee or insured who receives a bill or consolidated activity statement and bill from a contracted health care provider in violation of R.S. 22:1874(A), or a health insurance issuer acting on behalf of a…
La. Rev. Stat. § 22:1878 Exception
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§1878. Exception Regardless of any contractual provisions contained in a health insurance contract or plan delivered in this state, should a patient receive a dental or vision diagnosis from a contracted provider for which the patient qualifies for a covered dental or vision serv…
La. Rev. Stat. § 22:1879 Louisiana consumer health care provider network disclosure
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§1879. Louisiana consumer health care provider network disclosure A.(1) Within thirty days of the effective date of a new contract, each hospital or ambulatory surgical center, hereinafter referred to as "facility" or "contracted facility" for purposes of this Section, shall prov…
La. Rev. Stat. § 22:1880 Balance billing disclosure
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§1880. Balance billing disclosure A. Definitions. As used in this Section, the following terms shall be defined as follows: (1) "Balance billing" means any written or electronic communication by a non-contracted health care provider that appears to attempt to collect from an enro…
La. Rev. Stat. § 22:1880.1 Provider-based entity disclosure
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§1880.1. Provider-based entity disclosure If a facility meets the definition of a provider-based entity, as defined by 42 CFR 413.65, and the facility is located off of the main hospital campus, the facility shall publicly post a notice to every patient disclosing the following: …
La. Rev. Stat. § 22:1880.2 Payment of claims for covered healthcare services provided by out-of-network care
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§1880.2. Payment of claims for covered healthcare services provided by out-of-network care insurer of the enrollee receiving the covered healthcare services; definitions A. As used in this Section, the following definitions apply unless the context indicates otherwise: (1) "Ambul…
La. Rev. Stat. § 22:1881 Reimbursement of monies paid to health insurers under automobile medical payment provisions; limitation on amounts reimbursed
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§1881. Reimbursement of monies paid to health insurers under automobile medical payment provisions; limitation on amounts reimbursed A. Except as provided in this Section or by agreement between the parties and in accordance with regulations of the Department of Insurance governi…
La. Rev. Stat. § 22:1891 Automobile liability coverage, medical payments
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§1891. Automobile liability coverage, medical payments A policy of automobile liability insurance which provides for medical payments coverage shall not limit the time period during which the insured is entitled to payment or reimbursement for medical expenses incurred as a resul…
La. Rev. Stat. § 22:1892 Payment and adjustment of claims; policies other than life and health and accident;
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§1892. Payment and adjustment of claims; policies other than life and health and accident; good faith duty; breach of good faith duty; vehicle damage claims; extension of time to respond to claims during emergency or disaster; penalties; arson-related claims suspension; definitio…
La. Rev. Stat. § 22:1892.1 Arbitration or other type of binding mediation by automobile insurers
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§1892.1. Arbitration or other type of binding mediation by automobile insurers No automobile insurer shall use arbitration or any other type of binding mediation to determine fault for purposes of settling a claim resulting from an automobile accident for the purpose of raising i…
La. Rev. Stat. § 22:1892.2 Catastrophic loss claims settlement practices; penalties and attorney fees
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§1892.2. Catastrophic loss claims settlement practices; penalties and attorney fees A.(1) An insurer shall not violate any provision of this Section or R.S. 22:1892(A)(4) or (I). (2) For catastrophic losses arising under an insurance policy for residential property, an insurer sh…
La. Rev. Stat. § 22:1892.3 Payment of claims; property policies; proof of loss statements
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§1892.3. Payment of claims; property policies; proof of loss statements A. An insurer issuing any type of insurance policy, other than those specified in R.S. 22:1811 and 1821, and Chapter 10 of Title 23 of the Louisiana Revised Statutes of 1950, may require the claimant to submi…
La. Rev. Stat. § 22:1893 Claims involving immovable property
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§1893. Claims involving immovable property A.(1) No insurer shall use the floodwater mark on a covered structure without considering other evidence, when determining whether a loss is covered or not covered under a homeowners' insurance policy. (2) No insurer shall use the fact t…
La. Rev. Stat. § 22:1894 Filing claims; extension for claims arising from hurricane activity
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§1894. Filing claims; extension for claims arising from hurricane activity A. Notwithstanding any other provision of this Title to the contrary, any person or entity having a claim for damages pursuant to a homeowners' insurance policy, personal property insurance policy, tenant …