2021 Louisiana Laws
Revised Statutes
Title 22 - Insurance
§1878. Exception
RS 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 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, dental, or vision plan for treatment of the condition diagnosed.
(2) An alternate type, form, or quality of a dental or vision procedure or product to treat the diagnosed condition which procedure or product is of equal or greater price, provided that the patient approves the alternate procedure or product in advance and in writing. For alternate services, procedures, or products provided pursuant to this Subsection, the provider shall be paid for the dental or vision procedure or product as follows:
(a) The insurer shall pay the amount due for the covered procedure or product which was an approved service or product 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 or product and the amount of the chosen alternate service, procedure, or product.
Acts 2004, No. 607, §1; Redesignated from R.S. 22:250.48 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2020, No. 315, §1.
