TITLE 48

MONOPOLIES AND TRADE PRACTICES

CHAPTER 3

IDAHO PATIENT ACT

48-304.  requirements for extraordinary collection action. (1) No person shall engage, directly or indirectly, in any extraordinary collection action against a patient unless:

(a)  A health care provider submits its charges related to the provision of goods or delivery of services to the third-party payor of the patient, identified by the patient to the health care provider in connection with the services or, in the event no third-party payor was identified, to the patient, which submission of charges in either case shall be within forty-five (45) days from the latest of:

(i)   The date of the provision of goods or the delivery of services to the patient;

(ii)  The date of discharge of the patient from a health care facility; or

(iii) The first date permitted by the applicable billing code or codes and the applicable policies and procedures in connection with the patient’s care in each case as published by the relevant national association;

(b)  The patient receives a consolidated summary of services, free of charge, from the health care facility that the patient visited, unless the health care facility is exempted from providing a consolidated summary of services pursuant to section 48-309, Idaho Code, within sixty (60) days from the latest of:

(i)   The date of the provision of goods or delivery of services to the patient;

(ii)  The date of discharge of the patient from the health care facility; or

(iii) The first date permitted by the applicable billing code or codes and the applicable policies and procedures in connection with the patient’s care in each case as published by the relevant national association.

(c)  The patient receives, free of charge, a final notice before extraordinary collection action from the billing entity of the health care provider;

(d)  The health care provider does not charge or cause to accrue any interest, fees, or other ancillary charges until at least sixty (60) days have passed from the date of receipt of the final notice before extraordinary collection action or the consolidated summary of services, whichever is received later by the patient; and

(e)  At least ninety (90) days have passed from receipt of the final notice before extraordinary collection action or the consolidated summary of services, whichever is received later by the patient, and final resolution of all internal reviews, good faith disputes, and appeals of any charges or third-party payor obligations or payments; provided, however, that the ninety (90) days required by this paragraph may be shortened to forty-five (45) days for an extraordinary collection action as defined in section 48-303(3)(a)(ii), Idaho Code, if at least thirty (30) days prior to such action, the patient receives written notice that the health care provider may take an extraordinary collection action as defined in section 48-303(3)(a)(ii), Idaho Code, and that, as a consequence of taking such action, the health care provider will be prohibited from taking any extraordinary collection action as defined in section 48-303(3)(a)(iii), Idaho Code.

(2)  Any person taking an extraordinary collection action as defined in section 48-303(3)(a)(ii), Idaho Code, prior to ninety (90) days from the patient’s receipt of the final notice before extraordinary collection action shall be prohibited from pursuing an extraordinary collection action as defined in section 48-303(3)(a)(iii), Idaho Code.

(3)  No person shall engage, directly or indirectly, in any type of extraordinary collection action against a patient unless the final notice before extraordinary collection action includes both the name of the third-party payor to which the health care provider submitted charges related to the provision of goods or delivery of services to the patient and the patient’s group number and last four (4) digits of the patient’s membership number; provided, however, such requirement does not apply if the health care provider has submitted all charges in connection with the patient’s care to the patient’s correct third-party payor. Nothing in this subsection shall be construed to exempt a person from the requirements of subsection (1) of this section or section 48-306, Idaho Code.

History:

[48-304, added 2020, ch. 139, sec. 1, p. 428; am. 2022, ch. 263, sec. 2, p. 846.]