SB474 Alabama 2011 Session

Summary

Primary Sponsor

Tom Whatley

Republican

Session

Regular Session 2011

Title

Health care providers, certain health insurers, health maintenance organizations, statewide claim-dispute-resolution program established, Health Department to administer

Summary

SB474 would create a statewide, third‑party claim-dispute-resolution program for health care providers and certain health insurers/HMOs, administered by the Alabama Department of Public Health.

What This Bill Does

The Department of Public Health would establish a program by January 1, 2012 to help resolve health-care claim disputes that providers and health benefit plans cannot settle themselves. It would contract with a qualified independent resolution organization to review disputes and make recommendations to the department on how to resolve them. The department would set rules on which disputes can be reviewed (jurisdictional amounts and aggregation), require timelines and documentation, and adopt the organization’s recommended resolutions as final orders. The act also creates fee rules, penalties for nonpayment, and annual reports on compliance.

Who It Affects

• Health care providers and health benefit plans (insurers, HMOs, etc.) in Alabama whose disputes would be submitted to the resolution organization, subject to time limits and documentation requirements.
• The State Department of Public Health and the selected resolution organization, which would administer the program, review disputes, issue recommendations, and enforce final orders, including collecting costs and monitoring compliance.

Key Provisions

• Establish a statewide claim-dispute-resolution program by Jan 1, 2012 and contract with a resolution organization to review disputes unresolved between providers and health benefit plans.
• Define key terms (Department, Health Benefit Plan, Provider, Resolution Organization) and lay out eligibility and jurisdictional thresholds for disputes.
• Limit disputes to certain categories and exclude disputes related to interest only, outside jurisdiction, Medicare internal grievances, Medicaid fair hearings, ongoing court actions, or binding pre-existing dispute resolution agreements.
• Set filing and documentation timelines: disputes must be filed within 12 months of final determination; providers/plans must supply supporting documentation within 15 days of request; responses must be provided within 15 days; extensions allowed; failures can lead to dismissal or default.
• Resolution organization must issue written recommendations with findings within 60 days of receiving requested information, with a maximum 90-day review; the department must adopt the recommendation as a final order within 30 days.
• Costs and penalties: nonprevailing party pays review costs; penalties up to $500 per day for nonpayment; apportionment if both prevail in part.
• Monitoring and reporting: department monitors patterns of noncompliance and reports annually to Governor and Legislature.
• Rulemaking authority: department may adopt rules to administer the section.
• Effective date: becomes law on the first day of the third month after passage/approval.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health Care Providers