Frequently Asked Questions
Members
Providers
Brokers, Agents, Vendors
 
 
Members
 
Q: What is Receivership and Rehabilitation?
A: Receivership is a situation in which an insurance company is being held by a Receiver who is appointed by the Louisiana Commissioner of Insurance. The Receiver is charged with the custodial responsibility for the property of others in cases where the company is unable to meet its financial obligations.
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Q: Why did the Commissioner take this step?
A: Louisiana Health Cooperative (LAHC) is a failing insurance company placed in Receivership under a Permanent Order of Rehabilitation. The Receiver, appointed by Louisiana Commissioner of Insurance and approved by the court, has full legal authority over the company. The Receiver collects and organizes the assets of the insurer, determines the liabilities of the insurer to its providers, subscribers, members, agents and other creditors, and distributes the assets in satisfaction of such claims in accordance with a priority of distribution scheme prescribed by Louisiana law.
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Q: What happens if the Rehabilitation process is not successful?
A: There are times when the insurance company cannot be rehabilitated. When this happens, the Louisiana Department of Insurance through its court appointed Receiver may petition the 19th Judicial District Court to place the company into Liquidation.
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Q: Why am I receiving a notice and what does it mean?
A: Our records show that you had health insurance coverage with LAHC at some point during 2014 and/or 2015.
A: If you may have a claim against LAHC for unpaid benefits or a premium refund due related to your LAHC policy, you should complete the Proof of Claim Form and mail the notarized document to the address on the notice.

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Q: What happens if I didnít file my claim by March 31, 2016?
A: All proof of claim forms will still be accepted if submitted after the March 31, 2016 filing deadline. However, those claims are considered untimely and reimbursement will be paid after those claims filed on time (March 31st) if funds are available.
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Q: If my provider already filed my medical claims, should I still complete the attached form?
A: No, properly submitted health care claims (including all claims already filed) by health care providers will be considered sufficient to establish a claim with the LAHC Receiver for health care services without the need for the member to file an additional LAHC claim form.
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Q: Should I get an attorney to assist with my claim?
A: Enlisting the help of an attorney is not required. However, if your claim is completed and/or submitted on your behalf by an attorney, please provide their contact information.
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Q: If I file claims, will I get full reimbursement?
A: When all claims against LAHC are determined by the Receiver and approved by the Court, the Receiver will seek Court approval for payment based on available general assets. At this time the Receiver does not have enough assets to fully reimburse all claimants.
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Q: What type of information do you require for supporting documentation?
A: If your claim is for policy benefits, only submit copies of your medical claim if your physician has not done so. If your claim was denied because your coverage was terminated, do not resubmit the claim.
A: If your claim is for premium refund, submit copies of your premium payments and/or other proof along with an explanation of why a premium refund is due. 

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Q: How long will this process take?
A: It is unknown how long this process will take, however we do know it will take several months. The Receiver is working with the federal government to reconcile our records and determine our assets and liabilities. The Receiver is also working to reprocess claims in accordance with state Receivership laws and court orders. These steps are required for determining funds available to pay providers, policyholders subscribers, members, and other creditors. The Receiver has also filed for a Federal Waiver. Federal approval is required prior to the Receiver releasing funds to claimants. Periodic updates will be posted on LAHCís website.
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Q: How will I be notified of approval or denial?
A: A written notice of approval or denial in whole or in part will be mailed to the claimant at your address in our files. If your address changes it is your responsibility to notify LAHC of that change.
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Q: I lost my notice and claim form, can I get another one mailed to me?
A: Yes, the documents may be found on mylahc.org and on ldi.la.us
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Q: I have my claims form but lost the notice, can I get the address to mail my form?
A: Louisiana Health Cooperative, Inc. in Receivership
P.O. Box 7827
Metairie, LA 70010-7827

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Q: I have moved since submitting my claims, can you take my address change?
A: Yes, send it to the address in the above question.
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Q: I am not happy with the denial or partial approval of my claim, what is the next step?
A: Submit the denial or partial approval along with full explanation as to why you believe there is an error in LAHCís determination to the LAHC address above.
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Q: I am receiving a bill from the doctor, what should I do?
A: Pursuant to the September 21, 2015 order of the 19th Judicial District Court and Louisiana law, all network providers are prohibited from balance billing, requiring payment up front, refusing to treat, or, taking any recourse against the Louisiana Health Cooperative, Inc. policyholders, members, enrollees and subscribers, except for collecting applicable co-payment, co-insurance, or deductible amounts owed by you as determined and conveyed by LAHC. If you are being balance billed by an In-Network provider for amounts other than the member responsibility portion described above, please submit a copy of the bill along with your explanation to the address above or contact LAHC customer service. If you are balance billed by an out-of-network provider you are responsible for amounts not covered by LAHC. If you are balance billed by an out of network provider AND you did not have prior approval from LAHC you are responsible for ALL amounts billed by that provider.
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Q: Can I make a partial payment?
A: You cannot make a partial payment. If you owe premiums to LAHC you must pay these premiums so coverage remained in place to cover any claims you incurred up until December 31, 2015. Failure to pay any amounts owed to LAHC will result in retroactive termination of your policy and the provider will be notified so they may collect from you any unpaid amounts owed to him.
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Q: My invoice amount reflects a higher amount than my original premium quote.
A: An error may have occurred during the time of your enrollment. Contact the LAHC offices so your account can be reviewed.
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Q: Can I hand-deliver a check to the LAHC office?
A: No, a check or money order should be mailed to the following address:

Louisiana Health Cooperative, Inc. in Receivership
P.O. Box 7827
Metairie, LA 70010-7827


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Q: I did not use the service for ______ months. Why do I need to pay the full balance?
A: You must pay all premiums due. Whether you had claims or not isnít relevant.
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Providers
 
Q: Can we balance bill the member?
A: No, if you are an in-network provider. Pursuant to the September 21, 2015 order of the 19th Judicial District Court and Louisiana law, all network providers are prohibited from balance billing, or, taking any recourse against the Louisiana Health Cooperative, Inc. policyholders, members, enrollees, and subscribers, with the exception of collecting applicable co-payment, co-insurance, or deductible amounts as determined and conveyed by LAHC. If you are an out-of-network provider and LAHC gave prior authorization for the services provided to the member, you may bill the member responsibility amounts and those amounts above usual and customary charges once you receive a determination from LAHC. If the member did not have an authorization for the services provided, then LAHC will deny the entire claim and you may bill your entire charges.
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Q: Should we resubmit claims for reimbursement if we have not been paid?
A: No. Please note that filing claims previously received by LAHC will result in a charge of $10.00 per line (not per claim) for reprocessing.
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Q: What if I have questions about my contractual obligations with LAHC?
A: Contact the LAHC offices and have all pertinent information available to provide to the customer service representative.
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Q: How long will this process take
A: This process will take several of months. The Receiver is working with the federal government to reconcile our records and determine our assets and liabilities. The Receiver is also working to reprocess claims in accordance with state Receivership laws and court orders. These steps are required for determining funds available to pay providers, policyholders, and other creditors. The Receiver has also filed for a Federal Waiver. Federal approval is required from the United States Department of Justice prior to the Receiver releasing funds to claimants. Periodic updates will be posted on LAHCís website.
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Brokers, Agents, Vendors
 
Q: Why am I receiving this notice and what does it mean?
A: Our records show that you were a broker, agent, vendor, etc. of LAHC at some point during 2014 and/or 2015. If you have a claim against LAHC for unpaid commissions, unpaid legal or professional fees, unpaid vendor invoice, etc. you should complete the proof of claim form and mail it to the address on the notice by March 31, 2016.
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Q: How long will this process take?
A: This process will take several months. The Receiver is working with the federal government to reconcile our records and determine our assets & liabilities. The Receiver is also working to reprocess claims in accordance with state Receivership laws and court orders. Theses steps are required for determining funds available to pay providers, policyholders, and other creditors. The Receiver has also filed for a Federal Waiver. Federal approval is required from the United States Department of Justice prior to the Receiver releasing funds to claimants. Periodic updates will be posted on LAHC's website.
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