(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 of the provider contract as provided in this section, then the provider shall be entitled to recover in the circuit or district courts of this state from the company or agency responsible for the payment of the claim an amount equal to the value of such claim plus interest and a reasonable attorney’s fee to be determined by the court.
(b) Nothing in this section shall be construed to limit any insurer, health maintenance organization, preferred provider organization, health care service corporation, or other third party payor from determining the scope of its benefits or services or any other terms of its group and/or individual insured, subscriber or enrollee contracts nor from negotiating contracts with licensed providers on reimbursement rates or any other lawful provisions, except that the contract providing coverage to an insured may not exclude the right of assignment of benefits to any provider at the same benefit rate as paid to a contract provider.
(c) This section shall not apply to any persons covered under a state administered health benefit plan.
(Acts 1994, No. 94-638, p. 1197, §§1-6; Act 2001-445, p. 573, §1.)
Notes of Decisions
Blue Cross & Blue Shield v. Hodurski, 899 So. 2d 949 (Ala. 2004).
· cites it 4× “…know the existing law. Applying that principle to this case, we can presume that if the Legislature had intended for § 27-1-19 and §§ 27-19A-1 to -11, and §§ 27-45-1 to -9 to apply to companies like Blue Cross, it could have eliminated any question by expressly amending §…”
Blue Cross & Blue Shield of Alabama v. Nielsen, 917 F. Supp. 1532 (N.D. Ala. 1996).
· cites it 16× “94-638, Ala.Code § 27-1-19 (Supp.1995) (the “Assignment Act”) is preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”); that Blue Cross is not subject to the Assignment Act pursuant to Ala.”
Axelroth v. Health Partners of Alabama, 720 So. 2d 880 (Ala. 1998).
· cites it 32× “Axelroth sought compensatory and punitive damages, as well as injunctive relief, based on allegations that Health Partners had violated Ala.Code 1975, § 27-1-19, by refusing to reimburse him for services he had provided to one of his patients, and that Health Partners had…”
W.A. Griffin, MD v. Gen. Mills, Inc., 634 F. App'x 281 (11th Cir. 2015).
“5(a) (stating that a "contract issued pursuant to the provisions of this article shall not prohibit a subscriber under the contract from assigning, in writing, benefits under the contract to a licensed hospital or other licensed health care provider for services provided to the…”
Blue Cross & Blue Shield v. Nielsen, 142 F.3d 1375 (11th Cir. 1998).
· cites it 3× “See Ala.Code § 27-1-19(a) (Supp.1996). The Assignment Act also requires insurers or other entities providing health care plans to honor all assignments of benefits, notwithstanding any terms of the insurance or health plans to the contrary.”
— Ala. Code § 27-1-19(a) — 3 cases
Blue Cross & Blue Shield of Alabama v. Nielsen, 917 F. Supp. 1532 (N.D. Ala. 1996).
“94-638, Ala.Code § 27-1-19 (Supp.1995) (the “Assignment Act”) is preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”); that Blue Cross is not subject to the Assignment Act pursuant to Ala.”
Axelroth v. Health Partners of Alabama, 720 So. 2d 880 (Ala. 1998).
“Axelroth sought compensatory and punitive damages, as well as injunctive relief, based on allegations that Health Partners had violated Ala.Code 1975, § 27-1-19, by refusing to reimburse him for services he had provided to one of his patients, and that Health Partners had…”
Blue Cross & Blue Shield v. Nielsen, 142 F.3d 1375 (11th Cir. 1998).
“See Ala.Code § 27-1-19(a) (Supp.1996). The Assignment Act also requires insurers or other entities providing health care plans to honor all assignments of benefits, notwithstanding any terms of the insurance or health plans to the contrary.”
— Ala. Code § 27-1-19(b) — 1 case
W.A. Griffin, MD v. Gen. Mills, Inc., 634 F. App'x 281 (11th Cir. 2015).
“5(a) (stating that a "contract issued pursuant to the provisions of this article shall not prohibit a subscriber under the contract from assigning, in writing, benefits under the contract to a licensed hospital or other licensed health care provider for services provided to the…”
— Ala. Code § 27-1-19(d) — 2 cases
Blue Cross & Blue Shield of Alabama v. Nielsen, 917 F. Supp. 1532 (N.D. Ala. 1996).
“94-638, Ala.Code § 27-1-19 (Supp.1995) (the “Assignment Act”) is preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”); that Blue Cross is not subject to the Assignment Act pursuant to Ala.”
Blue Cross & Blue Shield v. Nielsen, 142 F.3d 1375 (11th Cir. 1998).
“See Ala.Code § 27-1-19(a) (Supp.1996). The Assignment Act also requires insurers or other entities providing health care plans to honor all assignments of benefits, notwithstanding any terms of the insurance or health plans to the contrary.”
— Ala. Code § 27-1-19(e) — 2 cases
Blue Cross & Blue Shield of Alabama v. Nielsen, 917 F. Supp. 1532 (N.D. Ala. 1996).
“94-638, Ala.Code § 27-1-19 (Supp.1995) (the “Assignment Act”) is preempted by the Employee Retirement Income Security Act of 1974 (“ERISA”); that Blue Cross is not subject to the Assignment Act pursuant to Ala.”
Axelroth v. Health Partners of Alabama, 720 So. 2d 880 (Ala. 1998).
“Axelroth sought compensatory and punitive damages, as well as injunctive relief, based on allegations that Health Partners had violated Ala.Code 1975, § 27-1-19, by refusing to reimburse him for services he had provided to one of his patients, and that Health Partners had…”
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