Louisiana (Louisiana) built out its surprise billing framework in stages:

• Balance billing disclosure / protections: through the Health Care Consumer Billing and Disclosure Protection Act, including La. R.S. 22:1880 (balance billing disclosure). 
• “No Surprises in Health Insurance Act of 2020” (SB 7 / SB 8 / SB 262-type bills): created a state independent dispute resolution process (IDR) for emergency services and “surprise bills”, with implementation around January 1, 2021. 

Then, on January 1, 2022, the federal No Surprises Act (NSA) took effect and became the primary framework for OON payment disputes.

Importantly, CMS classifies Louisiana as a “Federal IDR Process” state, not bifurcated — meaning Louisiana’s law protects consumers and creates a state IDR option, but is not treated as a “Specified State Law (SSL)” for NSA payment determinations.

Louisiana law addresses balance billing and surprise bills in multiple ways:

• Definition of balance billing – La. R.S. 22:1880 defines balance billing as attempts by a non-contracted providerto collect from an enrollee any amount not fully paid by the plan for covered or out-of-network services. 
• Disclosure requirements – Health insurance issuers must give a specific balance billing notice and facilities must provide notice about potential non-emergency OON services. 
• Hold harmless for certain “surprise bills” – Under the No Surprises in Health Insurance Act structure, when an insured assigns benefits for a surprise bill to a nonparticipating physician, that physician may not bill the patient beyond in-network cost share (copay, coinsurance, deductible). 
• Emergency services – Plans must ensure the insured does not incur higher out-of-pocket costs for covered emergency services with a nonparticipating physician than they would have with a participating physician. 

In short: Louisiana pushes financial liability back onto the plan–provider relationship, not the patient.

Louisiana law establishes a state-run dispute resolution process for certain bills: 

• Applies to emergency services and “surprise bills” from nonparticipating physicians for insured individuals in state-regulated plans (ERISA self-funded plans are explicitly excluded). 
• The Louisiana Department of Insurance certifies Independent Dispute Resolution (IDR) entities and administers the process. 
• Either the nonparticipating physician or the issuer can submit a dispute, once the plan has made an initial payment and tried to negotiate. 
• The IDR entity uses “baseball-style” arbitration – it must choose either the plan’s payment amount or the physician’s fee; no splitting the difference. 
• Determinations are binding on the plan, physician, and (where applicable) patient, and must generally be made within 30 days; if the provider wins, the plan must pay the difference within another ~30 days. 

This creates a state-level IDR lane for certain fully insured Louisiana claims outside of or alongside NSA.

Louisiana’s statute builds in a negotiation step similar in spirit to the NSA process: 

1. Bill received by the health insurance issuer for emergency services or a surprise bill from a nonparticipating physician.
2. The issuer must either:
   
   • Pay the billed amount, or
   • Attempt to negotiate a different reimbursement with the physician and then pay an amount it deems reasonable if negotiations fail.

1. If the parties still disagree, either may apply to the Department of Insurance for state IDR.

In parallel, federal NSA rules layer on a 30-day open negotiation period for NSA-eligible claims before Federal IDR is available. 

When a dispute goes to Louisiana’s state IDR, the entity must consider multiple factors in choosing between the plan’s amount and the physician’s fee, including: 

• Whether there is a gross disparity between the physician’s billed fee and:
  
  • Fees that physician receives from other non-contracted plans; and
  • Fees the plan pays similarly qualified physicians in the same region.
• The provider’s training, experience, and specialization.
• The complexity and circumstances of the services rendered.
• Other relevant, documented market and clinical factors.

This is state-specific arbitration and distinct from the QPA-centric analysis federal IDR uses.

Key Louisiana provisions include:

• La. R.S. 22:1880 – Balance billing disclosure; part of the Health Care Consumer Billing and Disclosure Protection Act. 
• La. R.S. 22:1885.5 et seq. (enacted via the “No Surprises in Health Insurance Act of 2020”, e.g., SB 7 / SB 8 / SB 262) – Establishes:
  
  • State dispute resolution for emergency services & surprise bills;
  • Department of Insurance authority to certify IDR entities;
  • Hold-harmless and assignment-of-benefits rules;
  • Binding arbitration standards and timelines. 

These state laws protect consumers and create an additional IDR avenue for certain fully insured disputes.

Despite having a state IDR statute, CMS’s official chart lists Louisiana under “Federal IDR Process” (not “Bifurcated Process”), meaning: 

• Louisiana’s surprise billing/IDR law is not treated as a “Specified State Law (SSL)” for determining the NSA out-of-network rate.
• For NSA-eligible items and services, including emergency OON care and OON services at in-network facilities, the Federal IDR process applies for determining the OON payment amount.

• For fully insured Louisiana plans, where the claim falls under NSA:
  
  • NSA governs payment methodology (QPA).
  • Federal IDR is the controlling arbitration forum for OON rate determination.
  • Louisiana SBL/IDR may apply in non-NSA scenarios or where the state statute is broader, but CMS expects NSA + Federal IDR to control OON rates for qualified IDR items and services. 
• For self-funded ERISA plans:
  
  • NSA + Federal IDR apply by default (Louisiana does not offer an opt-in SSL path).

So Louisiana is not “bifurcated” in the CMS sense — it’s effectively a Federal IDR state with extra state-law toolsfor some fully insured disputes.