§2232. Rights of each enrollee

A. Each enrollee shall have the right to courteous treatment, timely referral and access to specialty care, reasonable choice of providers as provided in the basic benefit plan, and confidential communications with caregivers as provided by law.

B. Any qualified plan shall provide to an enrollee or prospective enrollee information, orally or in writing, using understandable, objective, truthful, and consumer-tested terms, about the policy or plan prepared in a manner understandable at a fifth grade reading level and reviewed and approved by the literacy program of the Louisiana State University Health Sciences Center in Shreveport, including:

(1) The range of covered benefits, highlighting restrictions or limitations on basic services, specialty care, prescription drugs and biologics, "experimental" treatments, and the use of providers outside a plan's provider network.

(2) The amount of deductibles, copayments, and other potential out-of-pocket expenses.

(3) The cost of proposed services and fully itemized bills for services rendered.

(4) The expertise of available providers on specific diseases and disorders if a plan has a provider network.

(5) How "medically necessary" treatment is defined.

(6) How and whether coverage decisions can be fairly and simply appealed.

(7) The criteria for selecting and dismissing physicians if a plan has a provider network.

(8) Potential conflicts of interest or economic incentives on the part of providers which may influence care decisions.

Acts 1995, No. 1212, §1, eff. June 29, 1995; Acts 1999, No. 802, §5, eff. July 2, 1999.