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0 chapters · 1,747 sections in this title.
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 …
La. Rev. Stat. § 22:1895 Homeowner's insurance; claims payments and settlements
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§1895. Homeowner's insurance; claims payments and settlements No payment of a claim on a homeowner's insurance policy shall be considered a final settlement if the insurer fails to provide the insured with a statement that accurately reflects the amount paid under each category o…
La. Rev. Stat. § 22:1896 Right to transparency and integrity in adjustment of property claims
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§1896. Right to transparency and integrity in adjustment of property claims A. An insurer of a residential or commercial property shall respond to all inquiries or requests from the insured within fourteen days of the inquiry or request, unless such time period to respond has bee…
La. Rev. Stat. § 22:1897 Adjuster communications
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§1897. Adjuster communications A. For a personal residential insurance claim that arises due to a named storm or hurricane for which a state of emergency or disaster is declared pursuant to R.S. 29:724, and the insurer within a six-month period assigns a third or subsequent claim…
La. Rev. Stat. § 22:1898 Catastrophe claim process disclosure form; rules and regulations
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§1898. Catastrophe claim process disclosure form; rules and regulations A. The commissioner shall promulgate all rules and regulations for a catastrophe claims process disclosure form that shall include but not be limited to the following: (1) An explanation of the claims process…
La. Rev. Stat. § 22:19 Duration of licenses
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§19. Duration of licenses All licenses issued to foreign or domestic insurers of any kind, including fraternal benefit societies, producers, and all other persons, shall remain in effect until cancelled, suspended, revoked, or the renewal thereof refused, provided all requirement…
La. Rev. Stat. § 22:1901 Purpose; necessity for regulation
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§1901. Purpose; necessity for regulation This Part shall be liberally construed and applied to promote its underlying purposes which include: (1) Protecting persons seeking insurance in this state. (2) Permitting surplus lines insurance to be placed with reputable and financially…
La. Rev. Stat. § 22:1902 Transacting a business of insurance by unauthorized insurer defined
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§1902. Transacting a business of insurance by unauthorized insurer defined A. Any of the following acts in this state, effected by mail or otherwise, by an unauthorized insurer or by any person acting with actual or apparent authority of the insurer, on behalf of the insurer, is …
La. Rev. Stat. § 22:1903 Placement of insurance business; prohibitions and exclusions
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§1903. Placement of insurance business; prohibitions and exclusions A. An insurer shall not engage in the transaction of insurance unless authorized by a certificate of authority or otherwise is qualified pursuant to the laws of this state, or exempted by this Part or otherwise e…
La. Rev. Stat. § 22:1904 Insurance commissioner may institute legal proceedings against unauthorized insurer
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§1904. Insurance commissioner may institute legal proceedings against unauthorized insurer Whenever the commissioner of insurance believes, from evidence satisfactory to him, that any person or insurer is violating or about to violate any provision of this Part or any order or re…
La. Rev. Stat. § 22:1905 Domestic insurer prohibited from issuing policies in state where unauthorized; commissioner's approval required
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§1905. Domestic insurer prohibited from issuing policies in state where unauthorized; commissioner's approval required A. Subject to the exceptions set forth in Subsection C of this Section, no domestic insurer shall enter into a contract of insurance upon the life or person of a…
La. Rev. Stat. § 22:1906 Acting as agent for unauthorized insurer prohibited
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§1906. Acting as agent for unauthorized insurer prohibited A. No person shall act in this state as agent for any insurer not authorized to do business in this state. No person shall negotiate for or place or aid in placing insurance coverage or aid in effecting insurance or in tr…
La. Rev. Stat. § 22:1907 Transacting business; constitutes appointment of agent for service of process; workers' compensation claims agent
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§1907. Transacting business; constitutes appointment of agent for service of process; workers' compensation claims agent A. The transacting of business in this state by a foreign or alien insurer without a certificate of authority is equivalent to an appointment by such insurer o…
La. Rev. Stat. § 22:1908 Use of courts; prohibited to unauthorized insurer
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§1908. Use of courts; prohibited to unauthorized insurer No unauthorized insurer shall institute or file, or cause to be instituted or filed, any suit, action, or proceeding in this state to enforce any right, claim, or demand arising out of the transaction of business in this st…
La. Rev. Stat. § 22:1909 Requirements to be met before using courts
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§1909. Requirements to be met before using courts A. Before any unauthorized insurer shall file or cause to be filed any pleading in any action, suit, or proceeding instituted against it, such unauthorized insurer shall either (1) file with the clerk of the court in which such ac…
La. Rev. Stat. § 22:191 Definitions
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§191. Definitions For the purposes of this Subpart, the terms stated in this Section have the meanings assigned to them, respectively, unless the context otherwise requires: (1) "Nonprofit funeral service association" or "nonprofit association" means a corporation organized, inco…
La. Rev. Stat. § 22:1910 Validity of contracts illegally effectuated
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§1910. Validity of contracts illegally effectuated A contract of insurance effectuated by an unauthorized insurer in violation of the provisions of this Code shall be voidable except at the instance of the insurer. Acts 1958, No. 125; Redesignated from R.S. 22:1256 by Acts 2008, …
La. Rev. Stat. § 22:1911 Records of insureds
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§1911. Records of insureds Every person for whom insurance has been placed with an unauthorized insurer pursuant to or in violation of this Part shall, upon order of the commissioner of insurance, produce for his examination all policies and other documents evidencing the insuran…
La. Rev. Stat. § 22:192 Incorporation and qualification of incorporators
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§192. Incorporation and qualification of incorporators A.(1) Five or more natural persons who are residents of this state of full age, or fully relieved by emancipation of all disabilities attaching to minority, may form a nonprofit corporation, under the provisions of this Subpa…
La. Rev. Stat. § 22:1921 Purpose and powers
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§1921. Purpose and powers A. The purpose of this Part is to create within the Department of Insurance an office of insurance fraud. This office shall be charged with the responsibility, when directed by the commissioner of insurance, to conduct investigations and background crimi…
La. Rev. Stat. § 22:1922 Additional powers and duties
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§1922. Additional powers and duties A. The office of insurance fraud shall have access to computer systems, information maintained for the use of law enforcement personnel, any information contained in the criminal history record and identification file of the Louisiana Bureau of…
La. Rev. Stat. § 22:1923 Definitions
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§1923. Definitions As used in this Part, the following terms have the meanings indicated in this Section: (1) "Claim" shall mean any request or demand for payment or benefit, whether paid or not, made by a person either in writing or filed electronically. (2) "Fraudulent insuranc…
La. Rev. Stat. § 22:1924 Prohibited activities and sanctions
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§1924. Prohibited activities and sanctions A.(1)(a) Any person who, with the intent to injure, defraud, or deceive any insurance company, or the Department of Insurance, or any insured or other party in interest, or any third-party claimant commits any of the acts specified in Pa…
