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Started By
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re: Here are the details of the lead tort reform bill for the upcoming session.
Posted on 5/13/20 at 5:17 pm to tigersbb
Posted on 5/13/20 at 5:17 pm to tigersbb
quote:
if the system works as it should. If their loss ratios are reduced then the criteria for rate increases should govern this . The insurance commissioner could set a benchmark, if
Lotta ifs there hoss..IF my Aunt had nuts she'd be my uncle...
1
Posted on 5/13/20 at 5:36 pm to TigerGman
Identical bills came out of committee in both houses. This thing is rolling down the tracks. I don’t expect much in the way of amendments, as the republicans have the votes.
A bill will go to JBE’s desk. This will be interesting. If he vetoes it, it’s only a matter of time before the next governor signs it. This is the future.
A bill will go to JBE’s desk. This will be interesting. If he vetoes it, it’s only a matter of time before the next governor signs it. This is the future.
Posted on 5/13/20 at 5:37 pm to boosiebadazz
quote:
I’m including my insurance premiums I now have to pay for State Farm’s benefit as an element of damages sought
That would be a valid element of a claim. Would you agree only for the months it was used during the policy period? Could break it down to your individual pro-rata share of the premium if it insures more than you but for the sake of this exercise if you paid $500 / month for your health insurance and treated 4 months you would be entitled to $2,00.00 as an element of your claim.
Posted on 5/13/20 at 5:38 pm to tigersbb
Yeah, especially if I use it only for accident-elated treatment and not general health and wellness
Posted on 5/13/20 at 5:46 pm to boosiebadazz
quote:
Yeah, especially if I use it only for accident-elated treatment and not general health and wellness
In fairness, even if it was only a small part of your utilization the tort feasor should not be a scot free beneficiary of your being responsible.
Posted on 5/13/20 at 5:49 pm to udtiger
quote:
failure to wear a seat belt is inadmissible
Posted on 5/13/20 at 5:55 pm to El Magnifico
Welcome to LA were laws don’t make sense unless lawyers get paid
This post was edited on 5/13/20 at 5:56 pm
Posted on 5/13/20 at 5:59 pm to NIH
quote:
And adjusters would be sending tons of files to trial to test the waters.
I don't see this. Perhaps the ones with higher policy limits and a plaintiff case which insults the intelligence of reasonable people which excludes many judges. It may have the reverse effect and make the plaintiffs get more realistic and willing to compromise on issues like medical costs
The best adjusters are not the ones who quixotically try to hold on to every dollar. Neither are the best attorneys the ones who think they can intimidate adjusters and use their clients as pawns.
Posted on 5/13/20 at 6:42 pm to White Bear
quote:
From the Advocate article linked in your post: "... require lawsuits to be filed against the other driver, rather than the insurance company, called direct action;..."
Would this give a driver any additional power if he wants to fight a claim but the insurance company wants to settle? Or is that spelled out in the insurance policy, rather than being a function of who gets sued?
Posted on 5/13/20 at 6:57 pm to boosiebadazz
quote:
BCBS will pay what is presented and they’ll subrogate into the third party claim for what they’ve paid.
The problem is the medical providers will not bill BCBS and take the reduced rate when they can get 100 cents on the dollar from the third party claim.
I’m trying to understand how this happens. Presumably, two things are true:
1. The health insurance company is required to foot the bill, minus the copay and deductible.
2. Any in-network provider has a contract with the insurance company spelling out the rates.
So how does the provider simply refuse to bill the health insurance company? Even if it’s an out-of-network provider and the charges are higher, the health insurance policy already accounts for this with higher copays right?
It sounds like the only way a provider can simply refuse to bill the health insurance company would be if there’s a loophole somewhere - either in the in the policy, the contract with the provider, or the applicable laws. So where is it?
Posted on 5/13/20 at 7:00 pm to lostinbr
quote:
It sounds like the only way a provider can simply refuse to bill the health insurance company would be if there’s a loophole somewhere - either in the in the policy, the contract with the provider, or the applicable laws. So where is it?
They don’t accept you as a client if you are in an auto or work related accident and using insurance.
Posted on 5/13/20 at 7:00 pm to lostinbr
quote:
It sounds like the only way a provider can simply refuse to bill the health insurance company would be if there’s a loophole somewhere - either in the in the policy, the contract with the provider, or the applicable laws. So where is it?
The discretion of the compulsory provider (ER and ambulance) to bill the health insurer or code the claim on intake as MVA-related and hold it until a law firm requests records and then lien the file for the sticker price.
Other providers have discretion in which patients to see and can decline to see patients in car accidents or work-related accidents
ETA: and the proposed law states the Plaintiff is limited to his medical bills that “could” have been billed through insurance. So he’s at the mercy of the medical provider to bill his insurance and the proposed law has no requirement that they do so.
ER charges you $100 for a service your BCBS would have paid $30, State Farm only has to pay $30 under proposed law, and ER can get remaining $70 from you from what would be any money you’re awarded for pain and suffering
This post was edited on 5/13/20 at 7:09 pm
Posted on 5/13/20 at 7:10 pm to boosiebadazz
quote:
The discretion of the compulsory provider (ER and ambulance) to bill the health insurer or code the claim on intake as MVA-related and hold it until a law firm requests records and then lien the file for the sticker price.
I understand this is what they’re doing, I guess I’m asking where that discretion comes from. Is it a clause in their contract with the health insurance company, or is it a right the provider has under the law no matter what?
ETA:
quote:
ER charges you $100 for a service your BCBS would have paid $30, State Farm only has to pay $30 under proposed law, and ER can get remaining $70 from you from what would be any money you’re awarded for pain and suffering
What does the ER currently do if you lose in court? Charge you $100 or charge BCBS $30?
This post was edited on 5/13/20 at 7:12 pm
Posted on 5/13/20 at 7:12 pm to lostinbr
It’s their freedom to conduct their business as they see fit.
Acadian Ambulance stopped being a contracted provider a few years ago after being hit with a multi-million judgment for balance billing specifically to be able to do this.
Acadian Ambulance stopped being a contracted provider a few years ago after being hit with a multi-million judgment for balance billing specifically to be able to do this.
Posted on 5/13/20 at 7:14 pm to lostinbr
Open accounts have 3 year prescriptive period in La.
Some providers hire a lawyer to intervene and interrupt prescription but for most the cost of the lawyer doesn’t justify it.
If zero’D within three years, They technically still have a claim against the Plaintiff but good luck collecting. I think most health insurers have a time period by which claim has to be presented for payment .
Some providers hire a lawyer to intervene and interrupt prescription but for most the cost of the lawyer doesn’t justify it.
If zero’D within three years, They technically still have a claim against the Plaintiff but good luck collecting. I think most health insurers have a time period by which claim has to be presented for payment .
Posted on 5/13/20 at 7:34 pm to boosiebadazz
quote:
It’s their freedom to conduct their business as they see fit.
Acadian Ambulance stopped being a contracted provider a few years ago after being hit with a multi-million judgment for balance billing specifically to be able to do this.
Just looked this up...
quote:
"The result of this agreement is that Acadian agrees to file a claim with the patient's health insurance carrier, agrees to accept the contract reimbursement rate from the health insurance carrier as payment in full, and agrees to only seek deductibles, co-insurance, or co-payments from a patient after receiving an explanation of benefits from the health insurance company."
As far back as the 1990s Acadian implemented a company-wide policy for this class of patients.
In 2003, however, the state Legislature passed the Health Care Consumer Billing and Disclosure Act, which went into effect in January of the following year. The law prohibits a contracted health care provider from collecting or attempting to collect from a patient any amounts in excess of the contracted reimbursement rate, or any amounts that are the health insurance company's liability. "There are no exceptions in this law that allows a provider to act otherwise when treating a patient involved in a liability accident," Jeansonne writes.
So the court found that these billing practices were illegal in the presence of a contract with BCBS. You said yourself that Acadian stopped being a contracted provider for this reason. So wouldn’t that mean it’s also illegal for any other contracted provider to do the same? (Specifically thinking about ER visits here.)
And if Acadian isn’t a contracted provider, why would BCBS treat them differently than any other out-of-network provider?
Posted on 5/13/20 at 7:42 pm to lostinbr
quote:
So wouldn’t that mean it’s also illegal for any other contracted provider to do the same? (Specifically thinking about ER visits here.)
They’re not subject to the decision of that court. Contracted provider is a term of Art for balance billing. ER still retains option to bill insurance provided by patient absent state law mandating such
Posted on 5/14/20 at 4:50 am to lostinbr
quote:
"The result of this agreement is that Acadian agrees to file a claim with the patient's health insurance carrier, agrees to accept the contract reimbursement rate from the health insurance carrier as payment in full, and agrees to only seek deductibles, co-insurance, or co-payments from a patient after receiving an explanation of benefits from the health insurance company."
I remember when Acadian Ambulance was first started they would offer an annual family plan which protected you from being billed for any sums over whatever insurer they might collect from, usually a health insurer. I believe the annual family membership was $150,maybe less for a single person.
Posted on 5/14/20 at 6:39 am to Slippy
quote:
There are (so far) a handful of proposed evidentiary changes:
HB 78 provides that evidence of force of impact may be used to determine the causation of an injury and nature and extent of any injuries sustained
This sounds all well and good until people realize it’s absolute junk science. There was a 26 page federal court opinion in 2016 that provided a methodological and detailed analysis as to why a “force of impact” analysis has no admissibility in court. This tort “reform” bill is nothing more than a LABI creature that won’t do anything of substance to help Louisiana except to strip them of their rights.
Posted on 5/14/20 at 6:41 am to jbgleason
I was rear ended, last January. Fractured jaw, whip flash, I think the insurance company was shocked when I didn’t sue anyone
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