2022 Code of Alabama
Title 27 - Insurance.
Chapter 12 - Trade Practices Law.
Section 27-12-25 - Denying, Delaying, or Deferring Payment of an Otherwise Valid Claim for Payment of Health Care Services Prohibited Under Certain Circumstances.
Section 27-12-25
Denying, delaying, or deferring payment of an otherwise valid claim for payment of health care services prohibited under certain circumstances.
(a) Notwithstanding any other provision of law, any health insurer, any health care service plan organized under Article 6, Chapter 20, Title 10A, or any health maintenance organization organized under Chapter 21A of this title, which contracts for health insurance or pays for health care services, may not deny, delay, or defer payment of an otherwise valid claim for payment of health care services, because the insured, who is the injured person, has been or is being treated for injuries received under circumstances giving rise to a possible injury liability claim or a claim for benefits under an individual or group automobile insurance policy that provides uninsured motorist or medical payment coverage. Any provision in a health insurance policy or any provision in a hospital contract with a health care payor, as defined in Section 35-11-371, issued, entered into, amended, or renewed in this state on or after August 1, 2021, which attempts to coordinate benefits in violation of this section is void and unenforceable.
(b) This section does not restrict a health insurer, health care service plan, or health maintenance organization from recouping payments by exercising available subrogation rights against a responsible third party or by exercising available reimbursement rights against an injured person who is attempting to recover from, or has previously recovered from, a responsible third party or the injured party's uninsured or underinsured motorist insurance coverage, or both. Where a health insurer, health care service plan, or health maintenance organization seeks recoupment from a responsible third party, the amount of the recoupment may not exceed the amount paid by the health insurer, health care service plan, or health maintenance organization for health care services.
(c) The Department of Insurance shall adopt rules to carry out this section.
(Act 2021-379, §2.)
