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22-8A-11
Section 22-8A-11 Surrogate; requirements; attending physician consulted, intent of patient
followed; persons who may serve as surrogate; priority; validity of decisions; liability;
form; declaratory and injunctive relief; penalties. (a) If no advance directive for health
care has been made, or if no duly appointed health care proxy is reasonably available, or
if a valid advance directive for health care fails to address a particular circumstance, subject
to the provisions of subsection (c) hereof, a surrogate, in consultation with the attending
physician, may, subject to the provisions of Section 22-8A-6, determine whether to provide,
withdraw, or withhold life-sustaining treatment or artificially provided nutrition and hydration
if all of the following conditions are met: (1) The attending physician determines, to a reasonable
degree of medical certainty, that: a. The individual is no longer able to understand, appreciate,
and direct his or her medical treatment, and b. The individual...
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27-1-11
Section 27-1-11 Dentists and dental hygienists as "physicians" under health or accident
insurance policies. Whenever the terms "physician" and/or "doctor" are
used in any policy of health or accident insurance issued in this state or in any contract
for the provision of health care, services, or benefits issued by any health, medical or other
service corporation existing under, and by virtue of any laws of this state, said terms shall
include within their meaning those persons licensed under and in accordance with Chapter 9
of Title 34 in respect to any care, services, procedures, or benefits covered by said policy
of insurance or health care contract which the said persons are licensed to perform, any provisions
in any such policy of insurance or health care contract to the contrary notwithstanding. This
section shall be applicable to all policies in this state, regardless of date of issue, on
October 10, 1975. (Acts 1975, No. 1241, p. 2607, §1.)...
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27-3A-3
Section 27-3A-3 Definitions. As used in this chapter, the following words and phrases shall
have the following meanings: (1) DEPARTMENT. The Alabama Department of Public Health. (2)
ENROLLEE. An individual who has contracted for or who participates in coverage under an insurance
policy, a health maintenance organization contract, a health service corporation contract,
an employee welfare benefit plan, a hospital or medical services plan, or any other benefit
program providing payment, reimbursement, or indemnification for health care costs for the
individual or the eligible dependents of the individual. (3) PROVIDER. A health care provider
duly licensed or certified by the State of Alabama. (4) UTILIZATION REVIEW. A system for prospective
and concurrent review of the necessity and appropriateness in the allocation of health care
resources and services given or proposed to be given to an individual within this state. The
term does not include elective requests for clarification of...
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27-1-17.1
Section 27-1-17.1 Payment of providers through electronic funds transfer methods. (a) As used
in this section, the following words shall have the following meanings: (1) ACH ELECTRONIC
FUNDS TRANSFER. An electronic funds transfer through the Health Insurance Portability and
Accountability Act (HIPPA) standard Automated Clearing House network. (2) COVERED HEALTH CARE
PROVIDER. A physician as defined in Section 34-24-50.1; a dentist as defined in Section 34-9-1;
a chiropractor as defined in Section 34-24-120; an individual engaged in the practice of optometry
as defined in Section 34-22-1; other licensed health care professionals as defined in Title
34; a hospital as defined in Section 22-21-20; and a health care facility, or other provider
who or that is accredited, licensed, or certified and who or that is performing within the
scope of that accreditation, license, or certification. (3) HEALTH INSURANCE PLAN. Any hospital
and medical expense incurred policy, health maintenance...
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27-57-5
Section 27-57-5 Coverage by participating providers; selection criteria and utilization protocols;
maximum benefits, exclusions, etc. (a) This chapter does not require and shall not be construed
to require the coverage of services of providers who are not designated as covered providers,
or who are not selected as a participating provider, by a group health benefit plan or insurer
having a participating network of service providers. Nothing in this chapter is intended to
expand the list or designation of participating providers as specified in any health benefit
plan. (b) Insurers or other issuers of any health benefit plan covered by this chapter shall
continue to be able to establish and apply selection criteria and utilization protocols for
health care providers including the designation of types of providers for which coverage is
provided as well as credentialing criteria used in the selection of providers. (c) A group
health benefit plan, policy, or contract that provides coverage...
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27-58-4
Section 27-58-4 Benefits subject to annual deductible, coinsurance, exclusions, reductions,
etc. (a) The benefits provided in this chapter shall be subject to the same annual deductible
or coinsurance established for all covered benefits within a given policy. Private third party
payors may not reduce or eliminate coverage due to the requirements of this chapter. (b) A
health benefit plan subject to this chapter shall not terminate services, reduce capitation
payment, or otherwise penalize an attending physician or health care provider who orders medical
care consistent with this chapter. (c) Nothing in this chapter is intended to expand the list
of designations of covered providers as specified in any health benefit plan. (Act 2007-389,
p. 778, §4.)...
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27-59-3
Section 27-59-3 Implementation of coverage. (a) The benefits provided in this chapter shall
be subject to the same annual deductible or co-insurance established for all covered benefits
within a given policy. Private third party payors may not reduce or eliminate coverage due
to the requirements of this chapter. (b) A health benefit plan subject to this chapter may
not terminate services, reduce capitation payment, or otherwise penalize an attending physician
or health care provider who orders medical care consistent with this chapter. (c) Nothing
in this chapter is intended to expand the list of designations of covered providers as specified
in any health benefit plan. (Act 2008-502, p. 1106, §3.)...
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22-1-14
Section 22-1-14 Licensure Freedom Act. (a) State licensure requirements for physicians, chiropractors,
optometrists, and dentists in this state shall be granted based on demonstrated skill and
academic competence. Licensure approval for physicians, chiropractors, optometrists, and dentists
in this state may not be conditioned upon or related to participation in any public or private
health insurance plan, public health care system, public service initiative, or emergency
room coverage. (b) The licensure of dentists, osteopaths, chiropractors, optometrists, and
physicians shall be conducted exclusively pursuant to Chapter 9 of Title 34; Division 1, commencing
with Section 34-24-50, of Article 3 of Chapter 24 of Title 34; Article 4, commencing with
Section 34-24-120, of Chapter 24 of Title 34; Chapter 22 of Title 34; and Division 1, commencing
with Section 34-24-310, of Article 8 of Title 34, respectively. (c) Physician or optometric
licensure shall not be conditioned upon or related to...
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22-4-11
Section 22-4-11 Preparation, adoption, etc., of preliminary state health plan generally; provision
in plan for visual care. The State Board of Health, with the advice and consultation of the
Statewide Health Coordinating Council, is hereby authorized and empowered to prepare, review
and revise as necessary a preliminary state health plan which shall be made up of the health
systems plans of the health systems agencies within the state. The state agency may make revisions
of the health systems plans to achieve appropriate coordination or to deal more effectively
with statewide health needs. The preliminary state health plan shall be submitted to the statewide
health coordinating council for approval or disapproval and for its use in developing the
State Health Plan. The State Board of Health is authorized to confer with any or all other
persons, organizations or governmental agencies that have an interest in public health problems
and needs. Any portion of the State Health Plan that...
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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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