27-19A-7
Section 27-19A-7 Contracting directly with patient; distribution of information about policy or plan; payment and reimbursement procedures. The provisions of this chapter do not prohibit the following conduct and shall be construed to provide that: (1) A dentist may contract directly with a patient for the furnishing of dental care services to said patient as may be otherwise authorized by law; (2) Any person providing a health insurance policy or employee benefit plan, or an employer, or an employee organization may: a. Make available to its insureds, beneficiaries, participants, employees, or members information relating to dental care services by the distribution of factually accurate information regarding dental care services, rates, fees, location, and hours of service, provided such distribution is made upon the request of any dentist licensed by this state; or b. Establish an administrative mechanism which facilitates payment for dental care services by insureds, beneficiaries,...
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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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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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27-1-15
Section 27-1-15 Payment for services of podiatrist. Notwithstanding any other provision of law, when any contract of health insurance or any plan or agreement for health services provides for the reimbursement or payment for services which are within the scope of a podiatrist's professional license as defined in the general laws of Alabama, such policy shall be construed to include payment to a podiatrist who has performed such procedures. (Acts 1976, No. 678, p. 927.)...
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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.)...
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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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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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34-23-181
Section 34-23-181 Definitions. The following words shall have the following meanings as used in this article: (1) HEALTH BENEFIT PLAN. Any individual or group plan, employee welfare benefit plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, nonprofit medical service corporation, health care service plan, or any other person, firm, corporation, joint venture, or other similar business entity that pays for insureds or beneficiaries in this state. The term includes, but is not limited to, entities created pursuant to Article 6 of Chapter 20 of Title 10A. A health benefit plan located or domiciled outside of the State of Alabama is deemed to be subject to this article if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by 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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34-24-125
Section 34-24-125 Chiropractic agreements. (a) For the purposes of this section, the following words shall have the following meanings: (1) CHIROPRACTOR. A person licensed to practice chiropractic in this state. (2) CHIROPRACTIC AGREEMENT or AGREEMENT. A contract between a chiropractor and a patient or his or her legal representative in which the chiropractor or the chiropractor's chiropractic practice agrees to provide chiropractic services to the patient for an agreed upon fee and period of time. (3) CHIROPRACTIC PRACTICE. A chiropractor or a chiropractic practice of a chiropractor that charges a periodic fee for chiropractic services and which does not bill a third party any additional fee for services for patients covered under a chiropractic agreement. The per visit charge of the practice shall be less than the monthly equivalent of the periodic fee. (b) A chiropractic agreement is not insurance, may not be deemed an insurance arrangement, and is not subject to state insurance...
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