La. R.S. » RS
Louisiana Revised Statutes & Codes

La. Rev. Stat. § 40:2203.1 (2026)

Prohibition of certain practices by preferred provider organizations

✓ current as of May 2026
Find cases: SyfertCases citing this section LA-LEGlegis.la.gov JustiaTitle on Justia CornellLII Search CasesGoogle Scholar

§2203.1.  Prohibition of certain practices by preferred provider organizations

A.  Except as otherwise provided in this Subsection, the requirements of this Section shall apply to all preferred provider organization agreements that are applicable to medical services rendered in this state and to group purchasers as defined in this Part.  The provisions of this Section shall not apply to a group purchaser when providing health benefits through its own network or direct provider agreements or to such agreements of a group purchaser.

B.  A preferred provider organization's alternative rates of payment shall not be enforceable or binding upon any provider unless such organization is clearly identified on the benefit card issued by the group purchaser or other entity accessing a group purchaser's contractual agreement or agreements and presented to the participating provider when medical care is provided.  When more than one preferred provider organization is shown on the benefit card of  a group purchaser or other entity, the applicable contractual agreement that shall be binding on a provider shall be determined as follows:

(1)  The first preferred provider organization domiciled in this state, listed on the benefit card, beginning on the front of the card, reading from left to right, line by line, from top to bottom, that is applicable to a provider on the date medical care is rendered, shall establish the contractual agreement for payment that shall apply.

(2)  If there is no preferred provider organization domiciled in this state listed on the benefit  card, the first preferred provider organization domiciled outside this state listed on the benefit card, following the same process outlined in Paragraph (1) of this Subsection shall establish the contractual agreement for payment that shall apply.

(3)  The side of the benefit  card that prominently identifies the name of the insurer, or plan sponsor and beneficiary shall be deemed to be the front of the card.

(4)  When no preferred provider organization is listed, the plan sponsor or insurer identified by the card shall be deemed to be the group purchaser for purposes of this Section.

(5)  When no benefit card is issued or utilized by a group purchaser or other entity, written notification shall be required of any entity accessing an existing group purchaser's contractual agreement or agreements at least thirty days prior to accessing services through a participating provider under such agreement or agreements.

C.  A preferred provider organization agreement shall not be applied or used on a retroactive basis unless all providers of medical services that are affected by the application of alternative rates of payment receive written notification from the entity that seeks such an arrangement and agree in writing to be reimbursed at the alternative rates of payment.

D.  In no instance shall any provider be bound by the terms of a preferred provider organization agreement that is in violation of this Part.

E.  Any claim submitted by a provider for services provided to a person identified by the provider and a group purchaser as eligible for alternative rates of payment in a preferred provider agreement shall be subject to the standards for claims submission and timely payment according to the provisions of Subpart B of Part II of Chapter 6 of Title 22 of the Louisiana Revised Statutes of 1950.

F.  A group purchaser establishing a preferred provider organization shall be prohibited from charging a credentialing fee or any other type of monetary fee, when no access to a group purchaser is provided.  Any provider who participates in a preferred provider organization may be charged a reasonable fee either on a periodic basis or based on the tangible benefits received from continued participation in a preferred provider organization.  Such fees may be based on actual utilization of alternative rates of payment by group purchasers or other authorized entities or other reasonable basis other than membership.

G.  Failure to comply with the provisions of Subsection A, B, C, D, or F of this Section shall subject a group purchaser to damages payable to the provider of double the fair market value of the medical services provided, but in no event less than the greater of fifty dollars per day of noncompliance or  two thousand dollars, together with attorney fees to be determined by the court.  A provider may institute this action in any court of competent jurisdiction.

Acts 1999, No. 1274, §1, eff. July 12, 1999; Acts 2008, No. 415, §2, eff. Jan. 1, 2009.

NOTE:  See Acts 1999, No. 1274, §2.

Notes of Decisions
Cited in 50 cases (7 in the last 5 years), 2006–2026 · leading case: Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010).
Sort: Relevance Newest Treatment
Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010). · cites it 45× “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates, either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
First Health Settlement Class v. Chartis Speciality Ins., 111 A.3d 993 (Del. 2015). · cites it 38× “R.S. § 40:2203.1, and discussing the filing of Sw.”
CorVel Corp. v. Homeland Ins. Co. of New York, 112 A.3d 863 (Del. 2015). · cites it 30× “R.S. § 40:2203.1). 3 Williams v. SIF Consultants of Louisiana, Inc.”
Cent. Louisiana Ambulatory Surgical Ctr., Inc. v. Payless Shoesource, Inc., 46 So. 3d 689 (La. Ct. App. 2010). · cites it 17× “R.S. 40:2203.1, since the Employers gave no prior notice to CLASC as required by the statute.”
Touro Infirmary v. Am. Mar. Officer, 24 So. 3d 948 (La. Ct. App. 2009). · cites it 17× “R.S. 40:2203.1 G. This Court is aware of no relevant jurisprudence 2 .”
Touro Infirmary v. Am. Mar. Officer, 34 So. 3d 878 (La. Ct. App. 2010). · cites it 12× “R.S. 40:2203.1, et. seq. La. R.S. 40:2203.”
Gunderson v. Fa Richard & Assocs., 977 So. 2d 1128 (La. Ct. App. 2008). · cites it 16× “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
Williams v. SIF Consultants of Louisiana, Inc., 133 So. 3d 707 (La. Ct. App. 2014). · cites it 5× “R.S. 40:2203.1. After the trial court certified the plaintiff class, a partial motion for summary judgment was filed by the plaintiff class on the issue of coverage by the Executive Risk policies.”
Broussard Physical Therapy v. Fam. Dollar Stores, Inc., 5 So. 3d 812 (La. 2008). · cites it 2× “R.S. 40:2203.1 (the Louisiana Preferred Provider Organization Act) and La.”
Williams v. Homeland Ins. Co. of Ny, 657 F.3d 287 (5th Cir. 2011). · cites it 2× “R.S. 40:2203.1(B)(5). Without this notification, plaintiffs are less able to determine their rate reduction prior to rendering medical services.”
Agilus Health v. Accor Lodging North Am., 52 So. 3d 68 (La. 2010). · cites it 3× “R.S. 40:2203.1, and thus, the court properly ruled that the discount was invalid.”
Williams v. SIF Consultants of Louisiana, Inc., 103 So. 3d 1172 (La. Ct. App. 2012). · cites it 4× “R.S. 40:2203.1 by the insured party. Executive Risk and Homeland contend that such an action is prohibited by the direct action statute, La.”
Show all 50 citing cases →
La. Rev. Stat. § 40:2203.1(A): 8 cases
Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010). “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates, either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
CorVel Corp. v. Homeland Ins. Co. of New York, 112 A.3d 863 (Del. 2015). “R.S. § 40:2203.1). 3 Williams v. SIF Consultants of Louisiana, Inc.”
First Health Settlement Class v. Chartis Speciality Ins., 111 A.3d 993 (Del. 2015). “R.S. § 40:2203.1, and discussing the filing of Sw.”
Lake Charles Mem'l Hosp. v. Hobby Lobby Stores, Inc., 108 So. 3d 95 (La. Ct. App. 2010).
Wightman v. Ameritas Life Ins. Corp. (E.D. La. 2020).
La. Rev. Stat. § 40:2203.1(B): 14 cases
Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010). “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates, either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
CorVel Corp. v. Homeland Ins. Co. of New York, 112 A.3d 863 (Del. 2015). “R.S. § 40:2203.1). 3 Williams v. SIF Consultants of Louisiana, Inc.”
First Health Settlement Class v. Chartis Speciality Ins., 111 A.3d 993 (Del. 2015). “R.S. § 40:2203.1, and discussing the filing of Sw.”
Gunderson v. Fa Richard & Assocs., 977 So. 2d 1128 (La. Ct. App. 2008). “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
Gunderson v. Fa Richard & Assocs., 937 So. 2d 916 (La. Ct. App. 2006).
La. Rev. Stat. § 40:2203.1(B)(4): 2 cases
Wightman v. Ameritas Life Ins (5th Cir. 2023).
Wightman v. Ameritas Life Ins. Corp. (E.D. La. 2020).
La. Rev. Stat. § 40:2203.1(B)(5): 3 cases
Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010). “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates, either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
Williams v. Homeland Ins. Co. of Ny, 657 F.3d 287 (5th Cir. 2011). “R.S. 40:2203.1(B)(5). Without this notification, plaintiffs are less able to determine their rate reduction prior to rendering medical services.”
Musculoskeletal Inst. of Louisiana v. McDonald's Corp., 48 So. 3d 359 (La. Ct. App. 2010).
La. Rev. Stat. § 40:2203.1(G): 14 cases
First Health Settlement Class v. Chartis Speciality Ins., 111 A.3d 993 (Del. 2015). “R.S. § 40:2203.1, and discussing the filing of Sw.”
CorVel Corp. v. Homeland Ins. Co. of New York, 112 A.3d 863 (Del. 2015). “R.S. § 40:2203.1). 3 Williams v. SIF Consultants of Louisiana, Inc.”
Gunderson v. F.A. Richard & Assocs., 44 So. 3d 779 (La. Ct. App. 2010). “R.S. 40:2203.1 by failing to provide them with prior notice of their intent to reimburse at the PPO rates, either by providing the injured worker with a PPO card or by providing thirty days' written notice of their intent to utilize an existing PPO agreement.”
Williams v. SIF Consultants of Louisiana, Inc., 133 So. 3d 707 (La. Ct. App. 2014). “R.S. 40:2203.1. After the trial court certified the plaintiff class, a partial motion for summary judgment was filed by the plaintiff class on the issue of coverage by the Executive Risk policies.”
Williams v. Homeland Ins. Co. of Ny, 657 F.3d 287 (5th Cir. 2011). “R.S. 40:2203.1(B)(5). Without this notification, plaintiffs are less able to determine their rate reduction prior to rendering medical services.”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.