Print Friendly HOUSE BILL NO. 623
– Health provider, insurance, notice
HOUSE BILL NO. 623
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H0623......................................................by STATE AFFAIRS
HEALTH INSURANCE - Adds to existing law relating to health insurance to
provide for governing contract provider information; to require a notice by
providers; to specify content of the notice; to provide exceptions; and to
03/11 House intro - 1st rdg - to printing
03/12 Rpt prt - to Bus
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature Second Regular Session - 2008
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 623
BY STATE AFFAIRS COMMITTEE
1 AN ACT
2 RELATING TO HEALTH INSURANCE; AMENDING CHAPTER 1, TITLE 41, IDAHO CODE, BY THE
3 ADDITION OF A NEW SECTION 41-121, IDAHO CODE, TO PROVIDE FOR GOVERNING
4 CONTRACT PROVIDER INFORMATION; AND AMENDING CHAPTER 46, TITLE 54, IDAHO
5 CODE, BY THE ADDITION OF A NEW SECTION 54-4605, IDAHO CODE, TO REQUIRE A
6 NOTICE BY PROVIDERS, TO SPECIFY CONTENT OF THE NOTICE, TO PROVIDE EXCEP-
7 TIONS AND TO DEFINE TERMS.
8 Be It Enacted by the Legislature of the State of Idaho:
9 SECTION 1. That Chapter 1, Title 41, Idaho Code, be, and the same is
10 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
11 ignated as Section 41-121, Idaho Code, and to read as follows:
12 41-121. PROVISION GOVERNING PARTICIPATING PROVIDER INFORMATION. (1) Each
13 health insurance carrier, managed care organization or third party administra-
14 tor offering a contract for insurance or the administration of benefits in
15 this state shall maintain a site on the internet or a toll free telephone num-
16 ber that provides access to a current and complete directory of all contract-
17 ing providers and other health care professionals. This information shall be
18 updated on the first of each month.
19 (2) The health insurance carrier, managed care organization or third
20 party administrator shall regularly include the internet address or the toll
21 free telephone number providing access to a current list of participating
22 providers and other health care professionals with their regular information
23 mailing and written explanation of benefits.
24 SECTION 2. That Chapter 46, Title 54, Idaho Code, be, and the same is
25 hereby amended by the addition thereto of a NEW SECTION, to be known and des-
26 ignated as Section 54-4605, Idaho Code, and to read as follows:
27 54-4605. NOTICE BY PROVIDERS. (1) Providers, prior to the initial deliv-
28 ery of health care services to a patient, shall provide to the patient or the
29 patient's legal representative written notice of the following:
30 (a) A written list identifying the insurers with which the provider cur-
31 rently is a participating provider;
32 (b) That insurers may offer more than one (1) insurance product and may
33 have multiple provider networks. The provider may be a participating pro-
34 vider on some, but not all, of the insurer's products;
35 (c) If the provider is not a participating provider with the patient's
36 insurer, whether the provider will bill the patient for charges for health
37 care services in excess of the insurer's payment and the patient's payment
38 of a deductible, coinsurance or copayment;
39 (d) Whether the provider will charge the patient interest on the unpaid
40 balance, and the annual rate of interest that will be charged; and
41 (e) That the patient may inquire with the provider to ascertain whether
1 the provider is a participating provider and may contact the insurer to
2 verify whether the provider is a participating provider.
3 The written notice required in this subsection shall also provide space for
4 the patient to sign and acknowledge delivery of the notice.
5 (2) After the initial delivery of health care services to a patient, if
6 the provider's status as a participating provider with the patient's insurer
7 changes to nonparticipating, or if the patient provides documentation to the
8 provider of a change in the patient's insurer, before the delivery of addi-
9 tional health care services to the patient, the provider shall provide to the
10 patient or the patient's legal representative written notice as required in
11 subsection (1) of this section.
12 (3) If requested, either orally or in writing, the provider shall use its
13 best efforts to inform the patient whether the provider is a participating
15 (4) A provider shall not be required to provide the written notice
16 required in this section prior to the delivery of emergency health care ser-
17 vices to a patient; however, the provider shall provide the notice to the
18 patient or the patient's legal representative as soon thereafter as is practi-
20 (5) This section shall not apply to providers who do not have direct con-
21 tact with a patient, nor shall this section apply to providers who do not
22 admit a patient to a hospital or other facility but who provide care to that
23 patient after admission, except that if a patient admitted to a hospital or
24 other facility is required to sign an informed consent form for treatment by a
25 provider, the provider shall provide the written notice required in subsection
26 (1) of this section.
27 (6) A provider that does not provide the notice required by this section
28 shall not collect from the patient charges which are in excess of the payment
29 by the insurer, and the patient's payment of a deductible, coinsurance or
30 copayments pursuant to the patient's contract with the patient's insurer.
31 (7) As used in this section:
32 (a) "Emergency health care services to a patient" means those health care
33 services that are provided in a hospital after the sudden onset of a medi-
34 cal condition that manifests itself by symptoms including, but not limited
35 to, severe pain, of sufficient severity that the absence of immediate med-
36 ical attention could reasonably be expected by a prudent person who pos-
37 sesses an average knowledge of health and medicine to result in:
38 (i) Placing the patient's health in serious jeopardy;
39 (ii) Serious impairment of bodily functions; or
40 (iii) Serious dysfunction of any bodily organ or part.
41 (b) "Insurer" means any insurer that sells hospital, medical, long-term
42 care, dental or vision insurance policies or certificates, a subscriber
43 contract provided by a hospital or professional service corporation and
44 managed care organization. "Insurer" does not include policies or certif-
45 icates of insurance for specific diseases, hospital confinement indemnity,
46 accident-only, credit, medicare supplement, disability income insurance,
47 student health benefits only coverage issued as a supplement to liability
48 insurance, worker's compensation or similar insurance, automobile medical
49 payment insurance or nonrenewable short-term coverage issued for a period
50 of twelve (12) months or less.
51 (c) "Participating provider" means any provider or the employer of a pro-
52 vider who has executed, agreed to or entered into a direct, first party
53 written contract with an insurer to provide health care services.
STATEMENT OF PURPOSE
After medical treatment, patients may discover that their health
care provider has not contracted with their insurance company. As
a result, they are often faced with payment of the "balance of the
bill" out of their own funds. This legislation will require
disclosure to the patient at time of initial contact by the health
care provider as the whether they contract with the insurer. If the
disclosure is not provided, the health care professional will not
be able to "balance bill".
There is no fiscal impact to the General Fund.
Name: Representative Mark Snodgrass
STATEMENT OF PURPOSE/FISCAL NOTE H 623