Print Friendly HOUSE BILL NO. 704 – Health care billing disclosure
HOUSE BILL NO. 704
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H0704......................................................by STATE AFFAIRS
HEALTH CARE BILLING DISCLOSURE - Adds to existing law to require the
disclosure by health care providers and health insurance carriers of
certain information to patients; and to provide penalties.
02/28 House intro - 1st rdg - to printing
03/01 Rpt prt - to Bus
|||| LEGISLATURE OF THE STATE OF IDAHO ||||
Fifty-sixth Legislature Second Regular Session - 2002
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 704
BY STATE AFFAIRS COMMITTEE
1 AN ACT
2 RELATING TO HEALTH CARE BILLING; AMENDING TITLE 39, IDAHO CODE, BY THE ADDI-
3 TION OF A NEW CHAPTER 84, TITLE 39, IDAHO CODE, TO PROVIDE A SHORT TITLE,
4 TO REQUIRE DISCLOSURE OF CERTAIN INFORMATION BY HEALTH CARE PROVIDERS AND
5 HEALTH INSURANCE CARRIERS, TO PROVIDE AN EXCEPTION, TO PROVIDE FOR PENAL-
6 TIES, TO PROHIBIT RETALIATORY ACTIONS AND TO DEFINE TERMS.
7 Be It Enacted by the Legislature of the State of Idaho:
8 SECTION 1. That Title 39, Idaho Code, be, and the same is hereby amended
9 by the addition thereto of a NEW CHAPTER, to be known and designated as Chap-
10 ter 84, Title 39, Idaho Code, and to read as follows:
11 CHAPTER 84
12 HEALTH CARE BILLING DISCLOSURE ACT
13 39-8401. SHORT TITLE. This chapter shall be known and may be cited as the
14 "Health Care Billing Disclosure Act."
15 39-8402. DISCLOSURE REQUIRED. (1) Upon a patient's request, a health care
16 provider shall provide to a patient or to the legal representative of a
17 patient, prior to the delivery of any health care services, written notifica-
18 tion of the following information:
19 (a) The business name of the health insurance carrier or carriers with
20 which the health care provider participates and from which the health care
21 provider accepts reimbursement as payment in full after the payment of any
22 deductibles, copayments or coinsurance by the patient pursuant to the
23 patient's contract with the health insurance carrier;
24 (b) If the health care provider is not a participating or preferred pro-
25 vider with the patient's health insurance carrier, whether the health care
26 provider will bill the patient for the balance of any charges for health
27 care services which are not otherwise reimbursed by the patient's health
28 insurance carrier;
29 (c) Whether the health care provider will charge the patient interest on
30 the billed charges for the health care services and, if so, the annual
31 rate of the interest that will be charged;
32 (d) A reasonable range of the total charges for the anticipated health
33 care services provided or to be provided by the health care provider, if
34 such charges can reasonably be determined; and
35 (e) A general list of anticipated charges that may not be covered by the
36 patient's health insurance carrier including any charges that may exceed
37 the usual, customary or reasonable allowances of the health insurance car-
38 rier for purposes of reimbursement; provided however, that such list is
39 intended only to notify the patient of any possible additional charges
40 and, if provided prior to the rendering of health care services, shall not
41 limit the charges to be billed to the patient.
1 (2) Upon a patient's request, a health insurance carrier shall provide to
2 a patient or to the legal representative of a patient, prior to the delivery
3 of any health care services, written notification of the usual, customary or
4 reasonable allowances for which reimbursement will be provided by the health
5 insurance carrier for the anticipated health care services.
6 (3) If, following the initial delivery of health care services, there is
7 a change in either the health care provider's status as a participating or
8 preferred provider with the patient's health insurance carrier or in the
9 health care provider's business practice related to the billing of health care
10 services, the health care provider shall, upon a patient's request, provide to
11 the patient written notification of such changes prior to the delivery of any
12 additional health care services.
13 39-8403. EXCEPTION. A health care provider or health insurance carrier
14 shall not be required to provide written notification to the patient as set
15 forth in section 39-8402, Idaho Code, prior to the delivery of health care
16 services if such requirement would jeopardize the health or safety of the
17 patient; provided however, that the health care provider or health insurance
18 carrier shall provide such written notification to the patient or the legal
19 representative of the patient at the earliest opportunity following the deliv-
20 ery of health care services to the patient.
21 39-8404. FAILURE TO PROVIDE WRITTEN DISCLOSURE -- PENALTIES. (1) If a
22 health care provider fails to provide written notification upon request as
23 required in this chapter, a patient shall not be liable to the health care
24 provider for charges that are not covered by the patient's contract with a
25 health insurance carrier which are in excess of any deductibles, copayments or
26 coinsurance for which the patient is responsible pursuant to the patient's
27 contract with the health insurance carrier.
28 (2) In addition, if a health care provider or health insurance carrier
29 fails to provide written notification upon request as required in this chap-
30 ter, such provider or carrier shall be subject to a penalty of not more than
31 five thousand dollars ($5,000) for each violation. An action to recover the
32 civil penalty as provided in this subsection may be brought by a prosecuting
33 attorney. If the prosecuting attorney does not file an action for such civil
34 penalty within sixty (60) days from the date the action is requested by the
35 patient, the patient may file such action. Venue for such an action shall be
36 proper in the judicial district for the county in which the health care ser-
37 vices are or were to be provided or the county in which the respective health
38 care provider or health insurance carrier has its principal place of business
39 in this state.
40 (3) The penalties provided in this section are in addition to any other
41 remedy at law or equity available to a patient.
42 (4) Any civil penalty imposed pursuant to this section shall be deposited
43 in the state general fund. Attorney's fees shall be paid solely to the party
44 successfully bringing the action.
45 39-8405. RETALIATORY ACTION PROHIBITED. (1) A health insurance carrier
46 shall not terminate or nonrenew a contract with a health care provider, or
47 take other retaliatory action against a health care provider, based upon such
48 provider's disclosure to a patient of accurate information regarding health
49 care services to be rendered by the provider and coverage for such services by
50 a patient's health insurance carrier.
51 (2) Nothing in this section shall prohibit a contract provision that
52 requires any contracting party to keep confidential specific amounts paid to a
1 provider, provider fee schedules, provider salaries and other proprietary
2 information of a specified contract issued by a health insurance carrier.
3 39-8406. DEFINITIONS. As used in this chapter:
4 (1) "Health care provider" means any person or health care facility
5 licensed, registered, certified, permitted or otherwise officially recognized
6 by the state of Idaho to provide health care services in this state.
7 (2) "Health care services" means any services rendered to an individual
8 for diagnosis, treatment or care of any injury, ailment or bodily condition.
9 (3) "Health insurance carrier" means any entity that provides health
10 insurance in this state. For purposes of this chapter, carrier includes an
11 insurance company, a hospital or professional service corporation, a fraternal
12 benefit society, a health maintenance organization, any entity providing
13 health insurance coverage or benefits to residents of this state as certifi-
14 cate holders under a group policy issued or delivered outside of this state,
15 and any other entity providing a plan of health insurance or health benefits
16 subject to state insurance regulation.
17 (4) "Patient" means an individual who receives, or requests to receive,
18 health care services from a health care provider.
STATEMENT OF PURPOSE
Health care costs are escalating at a higher rate than ever before.
Health care providers, health insurance companies and health care
consumers (patients) are challenged as medical bills or accounts
receivable go unpaid, insurance premium rate hikes occur, and balance
billing practices surprise and shock consumers.
The purpose of this legislation is to provide for disclosure and
responsibility in the area of health care billing. Upon request,
providers would be required to inform patients if the health care
provider is a participating provider in a network, if the provider
accepts the patient s insurance, if the provider will "balance bill",
and also provide a reasonable range of total charges.
Also, upon request, a health insurance carrier will provide to a
patient prior to the delivery of any anticipated health care services
written notification of the usual, customary or reasonable allowances
for which reimbursement will be provided. Certain exceptions are
provided and penalties for failure to provide disclosure are set
Name: Rep. Kent Kunz
Phone: (208) 332-1000
STATEMENT OF PURPOSE/FISCAL NOTE H 704