Could a Louisiana provider assert an injury lien without overbilling an insured patient?

Plain-English summary

In 2005, the Louisiana Attorney General concluded that the state's health-care billing restrictions and provider-lien statute could operate together. The lien law allowed a health-care provider to claim reasonable charges or fees against an injured person's recovery in the circumstances it covered. The billing law restricted what a contracted provider could demand from an insured patient or that patient's health insurer under a plan contract.

The AG said a provider could not bill an enrollee or insured directly for an amount that was not the patient's contractual responsibility, nor bill the health carrier above the contracted reimbursement rate. That limit did not erase the provider-lien statute's operation against a third-party recovery. The opinion expressly framed the billing rules around contracted providers serving plan enrollees.

Currency note

This opinion was issued in 2005. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Did the billing restrictions discussed in this opinion eliminate provider liens? A: The AG said no. Providers could still assert liens for reasonable charges where the provider-lien statute applied.

Could a contracted provider bill the patient for an insurer's share? A: No. The opinion described “dual billing” as demanding from the insured an amount owed by the health insurer and said the contracted provider could not do that.

Could the provider bill the health carrier above its contracted rate? A: The AG said it could not hold the carrier responsible for an amount above the contracted reimbursement rate.

Did the billing restrictions apply to every provider and patient? A: The opinion tied them to a provider contracted with the patient's health plan and an enrollee or insured receiving covered services.

Background and statutory framework

Representative Troy Hebert asked if the Health Care Consumer Billing and Disclosure Act conflicted with LSA-R.S. 9:4752's provider lien. The AG quoted statutory definitions of “discount billing” and “dual billing,” then quoted the lien's reach to the net recovery payable to the injured person. It said the laws could be read together because the lien could address a third party or its insurer while the billing act controlled demands against the contracted provider's insured patient and health carrier. The PDF heading omits title 22 before 250.41; its body and footnotes identify the billing provisions as LSA-R.S. 22:250.42.

Citations

• LSA-R.S. 9:4752 (provider lien quoted in a footnote).
• LSA-R.S. 22:250.42(9) and (10) (billing definitions quoted in footnotes).

Source

• Landing page: https://www.ag.state.la.us/Opinions
• Original PDF: https://www.ag.state.la.us/Opinion/Download/05-0056

Original opinion text

May 17, 2005
Opinion Number 05-0056

61 Laws – general
LSR-R.S. 250.41 et seq. and LSA-R.S. 9:4752

No conflict exists between LSA-R.S. 250.41 et seq.
Honorable Troy Hebert and LSA-R.S. 9:4752. In general, health care
providers are free to execute liens for their
State Representative
reasonable charges or fees when appropriate.
Post Office Box 32
However, a provider may not attempt to hold an
Jeanerette, Louisiana 70544
enrollee/insured or their health insurance carrier as
the responsible party for any amount in excess of the contracted reimbursement rate under the
Dear Representative Hebert: applicable health insurance policy.

This office is in receipt of your request for an official Attorney General opinion. As I understand your question, you wish to know whether or not the Health Care Consumer Billing and Disclosure Act, (LSA R.S. 250.41 et seq.) conflicts with the Healthcare Provider Lien Statute (LSA R.S. 9:4752). In order to properly address this question, we must first look to the Health Care Consumer Billing and Disclosure Act (hereinafter the Billing and Disclosure Act).

The Billing and Disclosure Act prohibits two types of medical billing, discount billing and dual billing, defined as follows:

"Discount billing" means any written or electronic communication issued by a contracted health care provider that appears to attempt to collect from an enrollee or insured an amount in excess of the contracted reimbursement rate for covered services. (emphasis added)1

"Dual billing" means any written or electronic communication issued by a contracted health care provider that sets forth any amount owed by an enrollee or insured that is a health insurance issuer liability.2

It is important to note that the billing practices defined in both LSA-R.S. 22:250.42(9) and (10) govern transactions between an enrollee or insured and a contracted health care provider.3

1
LSA-R.S. 22:250.42(9)
2
LSA-R.S. 22:250.42(10)
3
LSA-R.S. 22:250.42(6) defines "contracted health care provider" as a health care provider that has entered into a contract or agreement directly with a health insurance

Page 2

Honorable Troy Hebert
Opinion 05-0056
Page 2

In general, statutory interpretation begins "as [it] must, with the language of the statute." Bailey v. United States, 516 U.S. 137, 116 S.Ct. 501, 506, 133 L.Ed.2d 472 (1995). Where a statute is clear and unambiguous, and its application does not lead to absurd results, the law shall be applied as written and no further interpretation may be made in search of the intent of the legislature. La. Civ.Code art. 9. Moreover, "[t]he plain meaning of legislation should be conclusive, except in the 'rare cases [in which] the literal application of a statute will produce a result demonstrably at odds with the intentions of its drafters' [in which case] the intention of the drafters, rather than the strict language controls." State v. Benoit, 817 So.2d 11(5/14/02).

It is apparent under the rules of statutory interpretation that in order for the Billing and Disclosure Act to apply, the health care provider must be contracted with the patient’s health insurance plan to provide services to its participants.

Next, we look to the Healthcare Provider Lien Statute (LSA-R.S. 9:4752) to determine if a conflict exists.4

In regard to amounts charged for professional services, LSA-R.S. 9:4752 only limits the amount of the lien to “reasonable charges or fees.” Nothing in this statute addresses contracted reimbursement rate as in the Billing and Disclosure Act. In fact, the charges or fees at issue in the Provider Lien Statute are not necessarily those which are the responsibility of the patient, but rather of a third party and/or its insurer.

When the LSA-R.S. 250.41 et seq. and LSA-R.S. 9:4752 are read together, it appears that the Billing and Disclosure Act does place one procedural limitation on the health care provider lien. That is, if a patient is an enrollee or insured covered by LSA-R.S. 250.41 et seq., a provider may not at any time “bill” the enrollee or insured directly for any amount that is not their responsibility nor may the provider bill the enrollee or insured’s health insurance carrier an amount in

issuer or with a health insurance issuer through a network of providers for the provision of covered health care services. LSA-R.S. 22:250.42(11) defines “enrollee” or “insured” as a person who is enrolled in or insured by a health insurance issuer for health insurance coverage 4 A health care provider, hospital, or ambulance service that furnishes services or supplies to any injured person shall have a privilege for the reasonable charges or fees of such health care provider, hospital, or ambulance service on the net amount payable to the injured person, his heirs, or legal representatives, out of the total amount of any recovery or sum had, collected, or to be collected, whether by judgment or by settlement or compromise, from another person on account of such injuries, and on the net amount payable by any insurance company under any contract providing for indemnity or compensation to the injured person.

Page 3

Honorable Troy Hebert
Opinion 05-0056
Page 3

excess of the contracted reimbursement rate.5 Clearly the purpose of LSA-R.S. 9:4752 is to place the burden of medical fees on the person alleged to be liable to the injured person and/or their insurance company, not the patient himself. Therefore, as long as a provider does not attempt to hold an enrollee/insured or their health insurance carrier as the responsible party for any amount in excess of the contracted reimbursement rate, there is no violation of the Billing and Disclosure Act.

Based upon the application of the rules of statutory construction to the language of LSA-R.S. 250.41 et seq. and LSA-R.S. 9:4752, it is the opinion of this office that no conflict exists between the two statues. In general, health care providers are free to execute liens for their charges or fees when appropriate as long as they do not bill an enrollee or insured directly for any fee that is not their contractual responsibility.

Very truly yours,

CHARLES C. FOTI, JR.
ATTORNEY GENERAL

BY: ______
Kristi M. Garcia
Assistant Attorney General

KMG:bh

5
LSA-R.S. 22:250.42(3) defines a “bill” as any written or electronic communication that sets forth the amount owed by an enrollee or insured. LSA-R.S. 22:250.42(7) defines “contracted reimbursement rate" means the aggregate maximum amount that a contracted health care provider has agreed to accept from all sources for provision of covered health care services under the health insurance coverage applicable to the enrollee or insured.

Page 4

Honorable Troy Hebert
Opinion 05-0056
Page 4
OPINION NUMBER 05-0056

61 LAWS - general

LSA-R.S. 250.41 et seq. and LSA-R.S. 9:4752

No conflict exists between LSA-R.S. 250.41 et seq. and LSA-R.S. 9:4752. In general, health care providers are free to execute liens for their reasonable charges or fees when appropriate. However, a provider may not attempt to hold an enrollee/insured or their health insurance carrier as the responsible party for any amount in excess of the contracted reimbursement rate under the applicable health insurance policy.

Honorable Troy Hebert
State Representative
Post Office Box 32
Jeanerette, Louisiana 70544

Date Received:
Date Released: May 17, 2005

KRISTI M. GARCIA
ASSISTANT ATTORNEY GENERAL