2011 Louisiana Laws
Revised Statutes
TITLE 22 — Insurance
RS 22:1878 — Exception
§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 diagnosis from a contracted provider for which the patient qualifies for a covered dental service pursuant to the patient's health plan, the patient may choose either of the following:
(1) The covered service designated by the patient's health or dental plan for treatment of the condition diagnosed.
(2) An alternate type, form, or quality of a dental procedure to treat the diagnosed condition which procedure is of equal or greater price, provided that the patient approves the alternate procedure in advance and in writing. For alternate services or procedures provided pursuant to this Subsection, the provider shall be paid for the dental procedure as follows:
(a) The insurer shall pay the amount due for the covered procedure which was an approved service for the treatment of the diagnosed condition.
(b) The patient shall pay that amount which is the difference between the amount of the covered service and the amount of the chosen alternate service or procedure.
Acts 2004, No. 607, §1; Redesignated from R.S. 22:250.48 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009.
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