2023 Louisiana Laws › Revised Statutes › Title 22 - Insurance › §22:1077.2. Required coverage for a patient's choice of medical and surgical treatment following a diagnosis of breast cancer

RS 22:1077.2 - Required coverage for a patient's choice of medical and surgical treatment following a diagnosis of breast cancer
A. The legislature hereby finds all of the following:
(1) Breast cancer was the most common cancer in Louisiana women from 2010 to 2014.
(2) Between 2010 and 2014, the average annual incidence rate of female breast cancer in Louisiana ranked twenty-ninth in the nation and approximately three thousand women will be diagnosed with breast cancer each year in Louisiana.
(3) The Carter Stokes Oral and Written Summary of Breast Cancer Treatment Alternatives and Access to Breast Reconstruction Surgery Information Law, R.S. 40:1103.1 et seq., requires the treating physician or surgeon to inform a patient diagnosed with any form of breast cancer of the alternative efficacious methods of treatment by discussing the alternative methods of treatment with the patient.
(4) Each woman facing breast cancer has to decide which treatment is right for her.
(5) Helping patients to maximize their autonomy in breast cancer decision-making is an important aspect of patient-centered care.
(6) Shared decision-making is a strategy that aims to maximize patient autonomy by integrating the values and preferences of the patient with the biomedical expertise of the physician.
B. The purpose of this Section is to stress that decisions regarding the treatment procedures to be performed following a diagnosis of breast cancer shall be made solely by the patient in consultation with attending physicians, and to clarify that all levels of medical and surgical treatment as provided for in this Section are medically necessary and shall not be excluded from coverage. Consulting physicians shall consider recognized, evidence-based standards such as the guidelines of the National Comprehensive Cancer Network in making treatment recommendations.
C.(1) Any health benefit plan offered by a health insurance issuer that provides medical and surgical benefits with respect to a partial mastectomy or a full unilateral or bilateral mastectomy shall provide coverage for the medical and surgical treatment and corresponding breast reconstruction chosen by a patient diagnosed with breast cancer in consultation with the attending physician regardless of whether a partial mastectomy or a full unilateral or bilateral mastectomy is chosen by the patient and physician.
(2) No health benefit plan offered by a health insurance issuer that provides medical and surgical benefits with respect to a partial mastectomy or a full unilateral or bilateral mastectomy shall deny coverage for those surgical procedures, including corresponding breast reconstruction, chosen by a patient diagnosed with breast cancer in consultation with the attending physician.
D. For purposes of this Section:
(1) "Breast reconstruction" has the same meaning as provided in R.S. 22:1077.
(2) "Health benefit plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health benefit plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.
(3) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including through a health benefit plan as defined in this Section, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits.
Acts 2019, No. 119, §1, eff. Jan. 1, 2021.