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34-19-21
Section 34-19-21 Coverage or reimbursement for services not required. Nothing contained in
this chapter shall be construed to create a requirement that any health benefit plan, group
insurance plan, policy, or contract for health care services 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 group health care services to patients, insureds, or beneficiaries in this state,
including entities created pursuant to Article 6, commencing with Section 10A-20-6.01, of
Chapter 20, Title 10A, provide coverage or reimbursement for the services described or authorized
in this chapter. (Act 2017-383, ยง4.)...
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36-29A-4
Section 36-29A-4 Workers' Compensation Law not applicable. Except as provided herein, the program
implemented pursuant to this chapter is not governed by or subject to the provisions of Act
92-537, or its successor, otherwise known as the Alabama Workers' Compensation Law or any
similar law. Payments made to physicians licensed to practice medicine for services to injured
employees shall be in accordance with the schedule of maximum fees as established under Section
25-5-313, or as otherwise permitted under Section 25-5-314. All undisputed medical reimbursements
or payments shall be made within twenty five (25) working days of receipt of claims in the
form specified in Section 25-5-3. There shall be added to any undisputed medical invoice which
is not paid within twenty five (25) working days an amount equal to ten (10) percent of the
unpaid balance. Any regulation, policy, or program directive for the conduct of utilization
review, bill screenings, and medical necessity determinations...
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25-5-312
Section 25-5-312 Powers and duties of the board. The board shall exercise general supervision
in all matters related to the provision of medical services provided by physicians, as defined
in Section 25-5-310, rendered to workers under this article. The duties of the board shall
include, but are not limited to, the following: (1) Study, develop, and implement any necessary
and reasonable guidelines for medical services and physician care provided by physicians.
In addition, with respect to services provided by physicians, the board shall study, develop,
and recommend to the secretary uniform medical criteria and policies for the conduct of utilization
review, bill screenings, and medical necessity determinations for use by insurance carriers,
self-insurers, and claims administrators. (2) Study, design, and implement standardized uniform
claims processing forms and forms for the reporting of medical information to employers and
insurance companies by physicians. (3) Address and give...
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27-19A-12
Section 27-19A-12 Dental services - Coverages; fees; exceptions. (a) As used in this section,
the following terms shall have the following meanings: (1) COVERED PERSON. Any individual,
family, or family member on whose behalf third-party payment or prepayment of health or medical
expenses is provided under an insurance policy, plan, or contract providing for third-party
payment or prepayment of health care or medical expenses. (2) COVERED SERVICES. Dental care
services for which a reimbursement is available under an enrollee's plan contract, or for
which a reimbursement would be available but for the application of contractual limitations
such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums,
frequency limitations, alternative benefit payments, or any other limitation. (3) DENTAL CARE
PROVIDER. A licensed dentist. (4) DENTAL PLAN. Includes any policy of insurance which is issued
by a health care service contractor which provides for coverage of...
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25-5-3
Section 25-5-3 Secretary to prepare and distribute forms, etc. The secretary shall prepare
and cause to be printed, at the expense of the state, and to be paid for as other supplies
are paid for, and upon request furnish free sample copies to any employer or employee the
blank forms and literature as he or she shall deem requisite to facilitate or promote the
efficient administration of Articles 2, 3, and 4 of this chapter, other than the papers relating
to court proceedings. The secretary shall adopt and cause a standardized claim reimbursement
form to be used by providers. The secretary shall also assist providers in developing a system
for electronic reporting, billing, and payment in workers' compensation cases. Standardized
claim reimbursement forms for physicians licensed to practice medicine and for other providers
shall be approved by the secretary and the Workers' Compensation Medical Services Board. If
the board and the secretary are unable to agree on a standardized claim...
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25-5-335
Section 25-5-335 Types of tests; procedures for specimen collection and testing; laboratory;
confirmation of tests. (a) An employer is required to conduct the following types of tests
in order to qualify for the workers' compensation insurance premium discounts provided under
this article: (1) An employer shall require job applicants to submit to a substance abuse
test after extending an offer of employment. Limited testing of job applicants by an employer
shall qualify under this article if the testing is conducted on the basis of reasonable classifications
of job positions. (2) An employer shall require an employee to submit to reasonable suspicion
testing. (3) An employer shall require an employee to submit to a substance abuse test if
the test is conducted as part of a routinely scheduled employee fitness-for-duty medical examination
that is part of the employer's established policy or that is scheduled routinely for all members
of an employment classification or group. (4) If the...
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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...
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27-48-1
Section 27-48-1 Definitions. As used in this chapter, the following terms shall have the following
meanings: (1) HEALTH BENEFIT PLAN. A health insurance policy 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. For
the purpose of this chapter, a health benefit plan located or domiciled outside of the State
of Alabama is deemed to be subject to the provisions of this chapter if it receives, processes,
adjudicates, pays, or denies claims for health care services submitted by or on behalf of
the State of Alabama or who receive health care services in the State of Alabama. The term
includes, but is not limited to, entities created pursuant to Article 6 of...
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27-51-1
Section 27-51-1 Payment for services of licensed physician assistant. (a) An insurance policy
or contract providing for third-party payment or prepayment of health or medical expenses
shall include a provision for the payment to a supervising physician for necessary medical
or surgical services that are provided by a licensed physician assistant practicing under
the supervision of the physician, and pursuant to the rules, regulations, and parameters for
physician assistants, if the policy or contract pays for the same care and treatment provided
by a licensed physician or doctor of osteopathy. (b) An insurance policy or contract subject
to this section shall not impose a practice or supervision restriction which is inconsistent
with or more restrictive than provided by law. (c) This section shall apply to services provided
under a policy or contract delivered, continued, or renewed in this state on or after August
1, 1997, and to any existing policy or contract, on the policy's or...
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2-15-1
Section 2-15-1 Department authorized to enter into contracts to perform inspection or testing
services, etc., for persons, firms, etc., engaged in business of marketing livestock; charge
and collection of fees for services rendered and disposition thereof. The Department of Agriculture
and Industries, acting by and through the Commissioner of Agriculture and Industries, with
approval of the State Board of Agriculture and Industries, is authorized and empowered to
enter into contracts with any person, firm, partnership, corporation or association engaged
in the business of marketing livestock whereby the Department of Agriculture and Industries,
on terms and conditions mutually agreed upon between the parties to such a contract, shall
perform any inspection or testing of livestock or any brand inspection or recording duties
required by law to be performed by such person, firm, partnership, corporation or association
engaged in the business of marketing livestock. The Department of...
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