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27-26-2
Section 27-26-2 Purpose of chapter. It is hereby declared by the Legislature of the State of
Alabama that the availability of medical liability insurance at reasonable rates for the medical
profession, medical institutions, and other health care providers is essential to provide
adequate health services to the people of Alabama, and without such insurance, medical services
by the medical profession may be curtailed, and that while the need for such insurance is
increasing, availability is limited and likely to become increasingly so, unless remedial
legislation is enacted. The Legislature further finds and declares that by reason of complicated
and highly technical medical concepts, and the existence of sophisticated medical techniques,
decisions with respect to optional procedures of diagnosis and treatment have become increasingly
complex and are necessarily made on the basis of professional judgment, on which opinions
may and often will reasonably vary. It is the purpose of this...
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22-6-224
Section 22-6-224 Medicaid Agency to contract for medical care; enrollment; delivery of services;
reimbursement. (a) Subject to approval of the federal Centers for Medicare and Medicaid Services,
the Medicaid Agency shall enter into contracts with one or more integrated care networks to
provide, pursuant to a risk contract under which the Medicaid Agency makes a capitated payment,
medical care to Medicaid beneficiaries assigned to the integrated care network. The Medicaid
Agency may enter into a contract pursuant to this section only if, in the judgment of the
Medicaid Agency, care of Medicaid beneficiaries would be better, more efficient, and less
costly than under the then existing care delivery system. Pursuant to the contract, the Medicaid
Agency shall set capitation payments for the integrated care network. (b) The Medicaid Agency
shall enroll beneficiaries it designates into an integrated care network consistent with guidance
from the Center for Medicare and Medicaid Services. (c)...
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27-52-30
Section 27-52-30 Consultation with State Board of Health. The commissioner shall consult with
the State Board of Health on all aspects related to the provision of medical services under
the Alabama Health Insurance Plan and the Alabama Small Employer Allocation Program established
under this chapter. All regulations, bylaws, policies, guidelines, or directives issued by
the commissioner applicable to the Alabama Health Insurance Plan and the Alabama Small Employer
Allocation Program pertaining to the delivery of medical services, including, but not limited
to, those items specified in subdivisions (8), (13), (14), (15) of Section 27-52-2 and Section
27-52-4, shall be promulgated with the concurrence of the State Board of Health. (Acts 1997,
No. 97-713, p. 1476, §9.)...
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27-19-39
Section 27-19-39 Policies, etc., providing for reimbursement for visual service. Whenever any
policy of insurance or any medical service plan or hospital service contract or hospital and
medical service contract provides for reimbursement for any visual service in Alabama which
is within the lawful scope of practice of a duly licensed optometrist, as defined in Section
34-22-1, the insured or other person entitled to benefits under such policy shall be entitled
to reimbursement for such services, whether such services are performed by a duly licensed
physician or by a duly licensed optometrist, whichever the insured selects, notwithstanding
any provision to the contrary in any statute or in such policy, plan, or contract. Duly licensed
optometrists shall be entitled to participate in such policies, plans, or contracts providing
for visual services to the same extent as fully licensed physicians. (Acts 1967, No. 508,
p. 1224.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/27-19-39.htm - 1K - Match Info - Similar pages
27-1-10
Section 27-1-10 Payment for health services of chiropractor; insured to have exclusive right
to select practitioner of healing arts. Any contract or policy of insurance or any plan or
agreement for health services providing for reimbursement or payment for health services performed
by a medical doctor or physician or upon the certification of a medical doctor, surgeon, osteopath
or physician, shall also reimburse or pay for such health services performed by a doctor of
chiropractic or upon his certificate; provided, that the health services performed by the
doctor of chiropractic are within the scope of his license and he is duly licensed by the
State of Alabama. The insured or such other person entitled to benefits under such contract
or policy of insurance or plan or agreement for health services shall have the exclusive right
to choose or select any practitioner or member of the healing arts of Alabama to perform such
services, notwithstanding any provisions of such contract or...
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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, §4.)...
alisondb.legislature.state.al.us/alison/CodeOfAlabama/1975/34-19-21.htm - 1K - 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...
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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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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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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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