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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...
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25-4-10
Section 25-4-10 Employment. (a) Subject to other provisions of this chapter, "employment"
means: (1) Any service performed prior to January 1, 1978, which was employment as defined
in this section prior to such date and, subject to the other provisions of this section,
services performed for remuneration after December 31, 1977, including service in interstate
commerce, by: a. Any officer of a corporation; or b. Any individual who, under the usual common
law rules applicable in determining the employer-employee relationship, has the status of
an employee; or c. Any individual other than an individual who is an employee under paragraphs
a. or b. of this subdivision (1) who performs services for remuneration for any person: 1.
As an agent-driver or commission-driver engaged in distributing meat products, bakery products,
beverages (other than milk) or laundry or dry cleaning services for a principal; 2. As a traveling
or city salesman engaged upon a full-time basis in the solicitation on...
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27-49-4
Section 27-49-4 Obstetricians and gynecologists as primary care physicians; direct access
to obstetrician and gynecologist not used as primary care physicians. (a) Each health benefit
plan which is issued, delivered, issued for delivery, or renewed in this state on or after
October 1, 1996, shall allow obstetricians and gynecologists as primary care physicians. This
subsection shall not be construed to require an individual obstetrician or gynecologist to
accept primary care physician status if the obstetrician or gynecologist does not wish to
be designated as a primary care physician, nor to interfere with the credentialing and other
selection criteria usually applied by a health benefit plan with respect to other physicians
within its network. (b) For women not using an obstetrician or gynecologist as their primary
care physician, no health benefit plan which is issued, delivered, issued for delivery, or
renewed in this state on or after October 1, 1996, shall require as a condition...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-49-4.htm - 2K - Match Info - Similar pages
27-48-3
Section 27-48-3 Prohibition against plan termination of services, reduction of capitation
payment, or other penalty for health care provider in compliance with chapter; prohibition
against financial encouragement of early discharge from postpartum care. No health benefit
plan subject to the provisions of this chapter shall terminate the services, reduce capitation
payment, or otherwise penalize an attending physician, certified nurse midwife, or other health
care provider who orders medical care consistent with this chapter. No health benefit plan
shall provide, directly or indirectly, any financial incentive or disincentive or grant or
deny any special favor or advantage of any kind or nature to any person to encourage or cause
early discharge of a hospital patient from postpartum care, excluding capitation or global
fee arrangements. Provided nothing contained in this chapter is intended to expand the list
or designation of covered providers as specified in any health benefit plan or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-48-3.htm - 1K - Match Info - Similar pages
27-19A-3
Section 27-19A-3 Prohibited provisions. No health insurance policy or employee benefit
plan which is delivered, renewed, issued for delivery, or otherwise contracted for in this
state shall: (1) Prevent any person who is a party to or beneficiary of any such health insurance
policy or employee benefit plan from selecting the dentist of his choice to furnish the dental
care services offered by said policy or plan or interfere with said selection provided the
dentist is licensed to furnish such dental care services in this state; (2) Deny any dentist
the right to participate as a contracting provider for such policy or plan provided the dentist
is licensed to furnish the dental care services offered by said policy or plan; (3) Authorize
any person to regulate, interfere, or intervene in any manner in the diagnosis or treatment
rendered by a dentist to his patient for the purpose of preventing, alleviating, curing, or
healing dental illness or injury provided said dentist practices within...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-3.htm - 1K - Match Info - Similar pages
27-19A-9
Section 27-19A-9 Nonconforming policies and plans not to be approved by commissioner.
The Commissioner of Insurance shall not approve for sale in this state any health insurance
policy or employee benefit plan providing for dental care services which does not conform
to the provisions of this chapter or to the provisions of Sections 27-14-8 and 27-14-9. (Acts
1984, No. 84-411, p. 960, ยง8.)...
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27-21A-15
Section 27-21A-15 Powers of insurers and health care service plans. (a) An insurance
company licensed in this state, or a health care service plan authorized to do business in
this state, may either directly or through a subsidiary or affiliate organize and operate
a health maintenance organization under the provisions of this chapter. Notwithstanding any
other law which may be inconsistent herewith, any two or more such insurance companies, health
care service plans, or subsidiaries or affiliates thereof, may jointly organize and operate
a health maintenance organization. The business of insurance is deemed to include the providing
of health care by a health maintenance organization owned or operated by an insurer or a subsidiary
thereof. (b) Notwithstanding any provision of insurance and health care service plan laws,
Title 10, Chapter 4, Article 6 and Title 27, an insurer or a health care service plan may
contract with a health maintenance organization to provide insurance or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-21A-15.htm - 1K - Match Info - Similar pages
27-1-19
Section 27-1-19 Reimbursement of health care providers. (a) The insured, or health or
dental plan beneficiary may assign reimbursement for health or dental care services directly
to the provider of services. Health benefits include medical, pharmacy, podiatric, chiropractic,
optometric, durable medical equipment, and home care services. The company or agency, when
authorized by the insured, or health or dental plan beneficiary, shall pay directly to the
health care provider the amount of the claim, under the same criteria and payment schedule
that would have been reimbursed directly to the contract provider, and any applicable interest.
This amount only applies to assigned claims. Any company or agency making a payment to the
insured, or health or dental plan beneficiary, after the rights of reimbursement have been
assigned to the provider of services, shall be liable to the provider for the payment. If
the company or agency fails to reimburse the provider in accordance with the terms...
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22-7A-1
Section 22-7A-1 Physician agreements; dentist agreements. (a) For the purposes of this
chapter, the following words shall have the following meanings: (1) DENTIST. A person licensed
to practice dentistry in this state. (2) DENTIST AGREEMENT or AGREEMENT. A contract between
a dentist and a patient or his or her legal representative in which the dentist or the dentist's
medical practice agrees to provide dental services to the patient for an agreed upon fee and
period of time. (3) DENTIST PRACTICE. A dentist or a dental practice of a dentist that charges
a periodic fee for dental services and which does not bill a third party any additional fee
for services for patients covered under a dental agreement. The per visit charge of the practice
shall be less than the monthly equivalent of the periodic fee. (4) PHYSICIAN. A person licensed
to practice medicine in this state. (5) PHYSICIAN AGREEMENT or AGREEMENT. A contract between
a physician and a patient or his or her legal representative in...
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34-14C-5
Section 34-14C-5 Exemptions. The licensure requirements of this chapter do not apply
to the following entities or practitioners: (1) Home health agencies certified by the State
of Alabama to participate in the Medicare and Medicaid programs. (2) Hospital based home medical
equipment services, whether or not the services are provided through a separate corporation
or other business entity. (3) Health care practitioners legally eligible to order or prescribe
home medical equipment, or who use home medical equipment to treat patients in locations other
than the patient's residence, including, but not limited to, physicians, nurses, physical
therapists, respiratory therapists, speech therapists, occupational therapists, optometrists,
chiropractors, and podiatrists, except for those practitioners, other than a licensed physician
practicing medicine, who provide home medical equipment services in a patient's residence.
Nothing in this chapter shall be construed as prohibiting or restricting...
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