RS 9:2800.27

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RS 9:2800.27

§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 sharing" means copayments, coinsurance, deductibles, and any other amounts which have been paid or are owed by the claimant to a medical provider.

(3)"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.

(4)"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.

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. 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.

E. In a trial to recover past medical expenses provided by Subsection B of this Section, the trier of fact shall be informed of the amounts billed and amounts actually paid for medical expenses that have been incurred by the claimant.

F. The recovery of past medical expenses other than those provided by Subsection B or C of this Section shall include the amounts paid to a medical provider by or on behalf of the claimant, and the amounts remaining owed to a medical provider, including medical expenses secured by a contractual or statutory privilege, lien, or guarantee.

G. In cases where the attorney for the claimant has entered into a pre-negotiated agreement with a medical provider of the claimant whereby the medical provider has agreed to accept as full compensation an amount less than the amount billed, a claimant's recovery of medical expenses shall be limited to the amount actually paid pursuant to the pre-negotiated agreement, and any applicable cost sharing amounts paid or owed by the claimant.

H. This Section shall not apply in cases brought pursuant to R.S. 40:1231.1 et seq., 1237.1 et seq., or to any benefits received by a party through a policy of automobile liability insurance that provides for medical payments coverage.

Acts 2020, 1 st Ex. Sess., No. 37, §4, eff. Jan. 1, 2021; Acts 2022, No. 511, §1; Acts 2025, No. 466, §1, eff. Jan. 1, 2026.