27-56-4
Section 27-56-4 Prohibited activities. An insurance policy, plan, or contract providing
for third-party payment or prepayment of health or medical expenses shall not do any of the
following: (1) Impose a practice restriction for optometrists which is inconsistent with or
more restrictive than provided by law. (2) Discriminate between classes of eye care providers
with respect to any covered service which falls within the scope of the eye care provider's
license. (3) Require an eye care provider to hold hospital privileges as a condition of participation
in or receiving payment from the policy, plan, or contract. (4) Impose any restriction not
required by law based on the eye care provider's professional degree. (5) Discriminate between
eye care providers in connection with the amount of reimbursement for the provision of the
same services. (6) Require an eye care provider to purchase or maintain a minimum quantity
or minimum dollar amount of a specified brand of ophthalmic materials as...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-4.htm - 1K - Match Info - Similar pages

27-56-10
Section 27-56-10 Vision care providers - Contract requirements; rates; reimbursements;
discounts. (a) As used in this section, the following words shall have the following
meanings: (1) CONTRACTUAL DISCOUNT. A percentage reduction from a provider's usual and customary
rate for covered services and materials required under a participating provider agreement.
(2) COVERED MATERIALS. Materials for which reimbursement from the insurer or vision care plan
is provided to a vision care provider by an enrollee's plan contract, or for which a reimbursement
would be available but for the application of the enrollee's contractual limitations of deductibles,
copayments, or coinsurance. (3) COVERED SERVICES. Services for which reimbursement from the
insurer or vision care plan is provided to a vision care provider by an enrollee's plan contract,
or for which a reimbursement would be available but for the application of the enrollee's
contractual plan limitations of deductibles, copayments, or...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-10.htm - 4K - Match Info - Similar pages

27-56-5
Section 27-56-5 Third-party payment. (a) No insurance policy, plan, or contract providing
for third-party payment or prepayment of health or medical expenses that provides coverage
for eye care services shall be issued or renewed after August 1, 2001, unless such insurance
policy, plan, or contract does the following: (1) Provides a covered person direct access
to any eye care provider participating in, or otherwise eligible to provide services under,
the policy, plan, or contract for all eye care services covered under the policy, plan, or
contract, without any referral or preapproval requirement, including, but not limited to,
the following services, if covered: a. Medical treatment of glaucoma. b. Postoperative eye
care. (2) Ensures that any list of medical or health care providers participating in, or otherwise
eligible to provide services under, the policy, plan, or contract includes eye care providers
to the same extent that such list includes other medical or health care...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-5.htm - 1K - Match Info - Similar pages

27-56-7
Section 27-56-7 Applicability to certain providers. (a) This chapter does not require
and shall not be construed to require any insurance policy, plan, or contract to provide health
care coverage for eye care. The provisions of this chapter are applicable only to those insurance
policies, plans, or contracts which provide coverage for eye care. (b) Insurers or other issuers
of any insurance policy, plan, or contract which provides coverage for eye care shall continue
to be able to establish and apply selection criteria and utilization protocols for health
care providers as well as credentialing criteria used in the selection of providers. (c) This
chapter does not require and shall not be construed to require the coverage of eye care services
by providers who are not designated as covered providers, or who are not selected as participating
providers, by an insurance policy, plan, or contract, or the issuer thereof having a participating
network of service providers. Provided, however,...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-7.htm - 1K - 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

27-56-8
Section 27-56-8 Implementation of coverage. (a) Any insurance policy, plan, or contract
that provides coverage for eye care services may contain provisions for maximum benefits and
coinsurance limitations, deductibles, exclusions, and utilization review protocols to the
extent that these provisions are not inconsistent with the requirements of this chapter. (b)
If eye care coverage is provided, the eye care benefits for services provided by optometrists
within the scope of their licenses shall be subject to the same annual deductible or coinsurance
established for all other eye care providers for which coverage is provided. (Act 2001-477,
p. 640, §8.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-8.htm - 975 bytes - Match Info - Similar pages

27-56-2
Section 27-56-2 Definitions. As used in this chapter, 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) EYE CARE PROVIDER. A licensed optometrist or a licensed ophthalmologist.
(3) INSURANCE POLICY, PLAN, OR CONTRACT PROVIDING FOR THIRD-PARTY PAYMENT OR PREPAYMENT OF
HEALTH OR MEDICAL EXPENSES. Includes an individual or group policy for accident or health
insurance, an individual or group hospital or health care service contract, an individual
or group health maintenance organization contract, an organized delivery system contract,
or a preferred provider organization contract, and any other similar policy, plan, or contract.
This term shall not include any employee welfare benefit plan, as defined...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-56-2.htm - 1K - Match Info - Similar pages

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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19A-12.htm - 2K - Match Info - Similar pages

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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-1-17.1.htm - 3K - Match Info - Similar pages

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...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-51-1.htm - 2K - Match Info - Similar pages