§2800.27. Recoverable past medical expenses; collateral sources; limitations; evidence
A. For the purpose of this Section:
(1) "Contracted medical provider" means any in-network medical provider that has
entered into a contract or agreement directly with a health insurance issuer or with a health
insurance issuer through a network of providers for the provision of covered healthcare
services at a pre-negotiated rate, or any medical provider that has billed and received
payment for covered healthcare services from Medicare when the provider is a participating
provider in those programs.
(2) "Cost of procurement" means the cost paid by or on behalf of the claimant to
procure the benefit paid by a health insurance issuer or Medicare and the cost of procurement
of the award of medical expenses, including but not limited to contracted attorney fees and
health insurance premiums paid.
(3) "Cost sharing" means copayments, coinsurance, deductibles, and any other
amounts which have been paid or are owed by the claimant to a medical provider.
(4) "Health insurance issuer" means any health insurance coverage through a policy
or certificate of insurance subject to regulation of insurance under state law, a health
maintenance organization, an employer-sponsored health plan, the Office of Group Benefits,
or an equivalent federal or state health plan.
(5) "Medical provider" means any healthcare provider, hospital, ambulance service,
or their heirs or assignees.
B. In cases where a claimant's medical expenses have been paid, in whole or in part,
by a health insurance issuer or Medicare to a contracted medical provider, the claimant's
recovery of medical expenses is limited to the amount actually paid to the contracted medical
provider by the health insurance issuer or Medicare, and any applicable cost sharing amounts
paid or owed by the claimant, and not the amount billed. The court shall award to the
claimant forty percent of the difference between the amount billed and the amount actually
paid to the contracted medical provider by a health insurance issuer or Medicare in
consideration of the claimant's cost of procurement, provided that this amount shall be
reduced if the defendant proves that the recovery of the cost of procurement would make the
award unreasonable. The determination of this award shall be made only in accordance with
the provisions of Subsection F of this Section.
C. In cases where a claimant's medical expenses have been paid, in whole or in part,
by Medicaid to a medical provider, the claimant's recovery of medical expenses actually paid
by Medicaid is limited to the amount actually paid to the medical provider by Medicaid, and
any applicable cost sharing amounts paid or owed by the claimant, and not the amount billed.
D. The recovery of past medical expenses other than those provided by Subsection
B or C of this Section shall be limited to amounts paid to a medical provider by or on behalf
of the claimant, and amounts remaining owed to a medical provider, including medical
expenses secured by a contractual or statutory privilege, lien, or guarantee. The
determination of this award shall be made only in accordance with Subsection F of this
Section.
E. In cases where a claimant's medical expenses are paid pursuant to the Louisiana
Workers' Compensation Law as provided in R.S. 23:1020.1 et seq., a claimant's recovery of
medical expenses is limited to the amount paid under the medical payment fee schedule of
the Louisiana Workers' Compensation Law.
F. In a jury trial, only after a jury verdict is rendered may the court receive evidence
related to the limitations of recoverable past medical expenses provided by Subsection B or
D of this Section. The jury shall be informed only of the amount billed by a medical provider
for medical treatment. Whether any person, health insurance issuer, or Medicare has paid
or has agreed to pay, in whole or in part, any of a claimant's medical expenses, shall not be
disclosed to the jury. In trial to the court alone, the court may consider such evidence.
G. This Section shall not apply in cases brought pursuant to R.S. 40:1231.1 et seq.
or 1237.1 et seq.
Acts 2020, 1st Ex. Sess., No. 37, §4, eff. Jan. 1, 2021; Acts 2022, No. 511, §1.