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16-25A-10
Section 16-25A-10 Payment to physician, hospital, etc., furnishing service or to insured. Any
benefits payable under the plan adopted may be paid either directly to the attending physician,
hospital, medical group or other furnishing the service upon which the claim is based or to
the insured employee upon presentation of valid bills for such services; subject to such provisions
designed to facilitate payment as may be made by the board. (Acts 1983, No. 83-455, p. 640,
§10.)...
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36-29-11
Section 36-29-11 Payment of benefits under plan. Any benefits payable under the plan adopted
may be paid either directly to the attending physician, hospital, medical group or other furnishing
the service upon which the claim is based or to the insured employee upon presentation of
valid bills for such services, subject to such provisions designed to facilitate payment as
may be made by the board. (Acts 1965, No. 833, p. 1564, §8.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/36-29-11.htm - 743 bytes - Match Info - Similar pages
27-1-17
Section 27-1-17 Limitation periods for payment of claims; overdue claims; retroactive denials,
adjustments, etc.; penalties. (a) Each insurer, health service corporation, and health benefit
plan that issues or renews any policy of accident or health insurance providing benefits for
medical or hospital expenses for its insured persons shall pay for services rendered by Alabama
health care providers within 45 calendar days upon receipt of a clean written claim or 30
calendar days upon receipt of a clean electronic claim. If the insurer, health service corporation,
or health benefit plan is denying or pending the claim, the insurer, health service corporation,
or health benefit plan shall, within 45 calendar days for a written claim and 30 calendar
days for an electronic claim, notify the health care provider or certificate holder of the
reason for denying or pending the claim and what, if any, additional information is required
to process the claim. Any undisputed portion of the claim...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.htm - 17K - Match Info - Similar pages
27-50-3
Section 27-50-3 Health benefit plan. As used in this chapter, the term "health benefit
plan" has the following meaning: A health insurance policy, including a self-insured
health plan, that covers hospital, medical, or surgical expenses, health maintenance organizations,
preferred provider organizations, medical service organizations, physician-hospital organizations,
or any other person, firm, corporation, joint venture, or other similar business entity that
pays for, purchases, or furnishes health care services to patients, insureds, or beneficiaries
in this state. The term does not include accident-only, specified disease, individual hospital
indemnity, credit, dental-only, Medicare-supplement, long-term care, or disability income
insurance; coverage issued as a supplement to liability insurance, workers' compensation or
similar insurance; or automobile medical-payment insurance. For the purpose of this chapter,
a health benefit plan located or domiciled outside of the State of...
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27-1-18
Section 27-1-18 Contract providing for mental health services to entitle insured to reimbursement
for outpatient and inpatient services by qualified psychiatrist or psychologist. (a) Whenever
any group, or blanket hospital or medical expense insurance policy or hospital or medical
service contract issued for delivery in this state provides for the reimbursement of health
or health related services which includes mental health services, and such services are within
the lawful scope of practice of a duly qualified psychiatrist or psychologist, the insured
or other person entitled to benefits under such policy or contract shall be entitled to reimbursement
for outpatient services, and inpatient services if requested by the attending physician, performed
by a duly qualified psychiatrist or psychologist notwithstanding any provisions of the policy
or contract to the contrary. (b) For purposes of this section, a duly qualified psychologist
means, one who is duly licensed or certified at the...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-18.htm - 2K - Match Info - Similar pages
27-1-22
Section 27-1-22 Uniform prescription drug information card or technology. (a) Every health
benefit plan that provides coverage for prescription drugs or devices, or administers a plan,
including, but not limited to, third party administrators for self-insured plans and state
administered plans, excluding the Alabama Medicaid Program, shall issue to its insureds a
card or other technology containing prescription drug information. The uniform prescription
drug information card or technology shall be in the format approved by the National Council
for Prescription Drug Programs (NCPDP) and shall include all of the required fields and conform
to the most recent pharmacy ID card or technology implementation guide produced by NCPDP or
conform to a national format acceptable to the Commissioner of Insurance. If a health care
plan includes a conditional or situational field, it shall conform to the most recent pharmacy
information card or technology implementation guide by the NCPDP or conform...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-22.htm - 3K - Match Info - Similar pages
27-54A-2
Section 27-54A-2 Treatment under certain policies and contracts. (a) As used in this section,
the following words have the following meanings: (1) APPLIED BEHAVIOR ANALYSIS. The design,
implementation, and evaluation of environmental modifications, using behavioral stimuli and
consequences, to produce socially significant improvement in human behavior, including the
use of direct observation, measurement, and functional analysis of the relationship between
environment and behavior. (2) AUTISM SPECTRUM DISORDER. Any of the pervasive developmental
disorders or autism spectrum disorders as defined by the most recent edition of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) or the edition that was in effect at the
time of diagnosis. (3) BEHAVIORAL HEALTH TREATMENT. Counseling and treatment programs, including
applied behavior analysis that are both of the following: a. Necessary to develop, maintain,
or restore, to the maximum extent practicable, the functioning of an...
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22-5A-6
Section 22-5A-6 Procedures for resolving complaints. (a) A community ombudsman's access to
any health care facility shall be limited to standard operating hours unless prior arrangements
with the operator of the facility has been made. If the complaint involves more than one provider
or alleges to involve more than one provider, the ombudsman shall investigate all providers.
(b) Any complaint requiring remedial action and deemed valid by the ombudsman shall be identified
and brought to the attention of the administrator or provider involved and followed up in
writing within a reasonable time. Upon receipt of such document, the administrator or provider,
in coordination with the ombudsman, shall establish a course of appropriate remedial action.
If the remedial action is not forthcoming within a reasonable time, the ombudsman must refer
the case to the State Ombudsman who may take any one or more of the following actions: (1)
Allow more time if the State Ombudsman has reason to believe...
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26-1A-404
regarding provision, withholding, or withdrawal of life-sustaining treatment and artificially
provided nutrition and hydration but only a. if specifically authorized to do so in the durable
power of attorney, b. if the substantive provisions of the durable power of attorney are in
substantial compliance and if the durable power of attorney is executed and accepted in substantially
the same form as set forth in the Alabama Natural Death Act, and c. in instances of terminal
illness or injury or permanent unconsciousness, if the authority is implemented in
the manner permitted under the Alabama Natural Death Act. All durable powers of attorney executed
prior to January 1, 2012, shall be effective to the extent specifically provided therein notwithstanding
the provisions of this subsection. The decisions made by the attorney in fact shall be implemented
in accordance with the same procedures set forth in the Alabama Natural Death Act for health
care proxies. (3) Any authority...
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26-1-2
regarding provision, withholding, or withdrawal of life-sustaining treatment and artificially
provided nutrition and hydration but only a. if specifically authorized to do so in the durable
power of attorney, b. if the substantive provisions of the durable power of attorney are in
substantial compliance and if the durable power of attorney is executed and accepted in substantially
the same form as set forth in the Alabama Natural Death Act, and c. in instances of terminal
illness or injury or permanent unconsciousness, if the authority is implemented in
the manner permitted under the Alabama Natural Death Act. All durable powers of attorney executed
prior to May 8, 1997, shall be effective to the extent specifically provided therein notwithstanding
the provisions of this subsection. The decisions made by the attorney in fact shall be implemented
in accordance with the same procedures set forth in the Alabama Natural Death Act for health
care proxies. (3) Any authority granted...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/26-1-2.htm - 12K - Match Info - Similar pages
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