Introduced Version






SENATE BILL No. 53

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-8-5.7-11; IC 27-13-36.2-9.

Synopsis: Adjustment of subsequent health coverage claims. Specifies that an insured or enrollee is not liable and may not be billed for an amount reimbursed to a health insurer or health maintenance organization through adjustment of a subsequent claim.

Effective: July 1, 2009.





Lawson C




    January 7, 2009, read first time and referred to Committee on Health and Provider Services.







Introduced

First Regular Session 116th General Assembly (2009)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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SENATE BILL No. 53



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 27-8-5.7-11; (09)IN0053.1.1. -->     SECTION 1. IC 27-8-5.7-11, AS ADDED BY P.L.55-2006, SECTION 2, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2009]: Sec. 11. (a) Every subsequent claim that is adjusted by an insurer for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including:
        (1) an identification of:
            (A) the claim on which the overpayment was made; and
            (B) if ascertainable, the party financially responsible for the overpaid amount; and
        (2) the amount of the overpayment that is being reimbursed to the insurer through the adjusted subsequent claim.
     (b) An insured:
        (1) is not liable; and
        (2) may not be billed by a provider;
for any amount reimbursed to the insured's insurer through an adjusted subsequent claim.

SOURCE: IC 27-13-36.2-9; (09)IN0053.1.2. -->     SECTION 2. IC 27-13-36.2-9, AS ADDED BY P.L.55-2006, SECTION 4, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2009]: Sec. 9. (a) Every subsequent claim that is adjusted by a health maintenance organization for reimbursement on an overpayment of a previous provider claim made to the provider must be accompanied by an explanation of the reason for the adjustment, including:
        (1) an identification of:
            (A) the claim on which the overpayment was made; and
            (B) if ascertainable, the party financially responsible for the amount overpaid; and
        (2) the amount of the overpayment that is being reimbursed to the health maintenance organization through the adjusted subsequent claim.
     (b) An enrollee:
        (1) is not liable; and
        (2) may not be billed by a provider;
for any amount reimbursed to the enrollee's health maintenance organization through an adjusted subsequent claim.