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Office of Health Insurance
Main phone: (225) 219-4770 Toll Free: (800) 259-5301
Fax: (225) 342-5711 The Office of Health Insurance was created in 1998 to consolidate the regulations of state and federal requirements applicable to commercial and government operated health benefit plans. This Office provides protection to Louisiana consumers, assures continued viability of health benefit plans and determines whether enhancements or modifications are necessary to assure continued compliance. There are five divisions in operation. Executive Staff
Louisiana Health Care Commission (LHCC)
The Louisiana Health Care Commission (LHCC) is a forty six (46) member advisory board to the Commissioner of Insurance on health care issues. The commission examines all health policy developed by the Department of Insurance. The commission makes recommendations to the Commissioner of Insurance on all such policy, as well as makes recommendations for reform of the health care and health insurance systems in Louisiana.
Senior Health Insurance Information Program
The Senior Health Insurance Information Program (SHIIP) offers specialized services to senior citizens and Medicare beneficiaries. SHIIP offers a wide range of information and materials through the Department of Insurance's toll-free telephone line. To request information, counseling, publications, a speaker for a group or information on becoming a sponsor, you may call (800) 259-5301 to reach a staff person or e-mail vdufrene@ldi.la.gov. To request a publication online, click here.
HIPAA Quality Management Division
The HIPAA Quality Management Division administers the operational functions of commercial and government operated health benefit plans in Louisiana.
Quality Management Consumer Affairs Unit The Quality Management Consumer Affairs Unit provides direct assistance and protection to consumers and health care providers regarding issues which impact health insurance, through complaint investigations and consumer inquires, as well as interaction with federal and state agencies. These issues include benefit coverage, payment of claims and refunds, advertising, marketing, underwriting, changes in coverage, access to managed care providers and covered services, contractual terms and provisions, and policyholder service to assure compliance with all applicable state and federal laws, rules and regulations. Our regulatory authority extends to those major medical health plans, which are fully insured that are delivered and issued by an insurer licensed in this state.
Quality Management Insurance Contracts and Forms Unit The Quality Management Insurance Contracts and Forms Unit is responsible for performing detailed analysis and reviews of all health benefit plan filings to assure compliance with all applicable state and federal laws, rules and regulations. Examiners of this unit can assist you with the interpretation of statutes, rules and regulations, filing procedures and fees, and status requests on pending filings. This unit also performs annual surveys and audits to determine the appropriate amount of accident and health insurance premiums subject to HIPAA assessment.
Supplemental Health Products/MNRO Division
Supplemental Health Products Unit The Supplemental Health Products Unit is responsible for performing detailed analysis and review of all Medicare supplemental benefit plan filings to assure compliance with all applicable state and federal laws, rules and regulations. This unit is also responsible for the review and approval of all limited benefit plan filings to assure compliance with all state filing procedures. Examiners assist with the interpretation of statutes, rules and regulations, filing procedures and fees, status requests on pending filings as well as answer inquiries and conduct investigations of consumer complaints relative to limited benefit and supplemental health insurance products. These include but are not limited to the following:
The MNRO Unit assures compliance by Medical Necessity Review Organizations by requiring uniform standards for such organizations, specifically internal and external grievance procedures to appeal adverse medical necessity determinations, so that all health plans follow the same standards in resolving disputes. This unit also assures compliance by all health insurance issuers in following procedures and timeframes for the payment of health services, standards for the credentialing of providers by health insurance issuers, as well as standards regarding notices and disclosures outlined in the Health Care Consumer Billing and Disclosure Protection Act of 2003.
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