TITLE 48

MONOPOLIES AND TRADE PRACTICES

CHAPTER 3

IDAHO PATIENT ACT

48-303.  DEFINITIONS. For the purposes of this chapter:

(1)(a)  "Consolidated summary of services" means a written notice that contains, at a minimum, the following:

(i)   The name and contact information, including telephone number, of the patient;

(ii)  The name and contact information, including telephone number, of the health care facility that the patient visited to receive goods or services;

(iii) The date and duration of the visit to the health care facility by the patient;

(iv)  A general description of goods and services provided to the patient during the visit to the health care facility, including the name, address, and telephone number of each billing entity whose health care providers provided the services and goods to the patient; and

(v)   A clear and conspicuous notification at the top of the notice that states: "This is Not a Bill. This is a Summary of Medical Services You Received. Retain This Summary for Your Records. Please Contact Your Insurance Company and the Health Care Providers Listed on this Summary to Determine the Final Amount You May Be Obligated to Pay."

(b)  For the purpose of calculating timeline requirements in this chapter in the event of multiple notices, a "consolidated summary of services" means the notice that first supplied the information required by paragraph (a) of this subsection if such information did not change in any subsequent notices.

(2)  "Contested judgment" means a court judgment sought by one (1) party that is challenged by another party through a filing with the court or by presenting evidence or argument at a hearing before the court.

(3)(a)  "Extraordinary collection action" means any of the following actions done in connection with a patient’s debt:

(i)   Prior to sixty (60) days from the patient’s receipt of the final notice before extraordinary collection action, selling, transferring, or assigning any amount of a patient’s debt to any third party, or otherwise authorizing any third party to collect the debt in a name other than the name of the health care provider;

(ii)  Reporting adverse information about the patient to a consumer reporting agency; or

(iii) Commencing any judicial or legal action or filing or recording any document in relation thereto, including but not limited to:

1.  Placing a lien on a person’s property or assets;

2.  Attaching or seizing a person’s bank account or any other personal property;

3.  Initiating a civil action against any person; or

4.  Garnishing an individual’s wages.

(b)  "Extraordinary collection action" does not include an action pursuant to and in compliance with section 28-22-105, Idaho Code.

(4)(a)  "Final notice before extraordinary collection action" means a written notice that contains, at a minimum, the following:

(i)   The name and contact information, including telephone number, of the patient;

(ii)  The name and contact information, including telephone number, of the health care facility where the health care provider provided goods and services to the patient;

(iii) A list of the goods and services that the health care provider provided to the patient during the patient’s visit to the health care facility, including the initial charges for the goods and services and the date the goods and services were provided, in reasonable detail;

(iv)  A statement that a full itemized list of goods and services provided to the patient is available upon the patient’s request;

(v)   The name of the third-party payors to which the charges for health care services were submitted by the health care provider;

(vi)  A detailed description of all reductions, adjustments, offsets, third-party payor payments, including payments already received from the patient, that adjust the initial charges for the goods and services provided to the patient during the visit; and

(vii) The final amount that the patient is liable to pay after taking into account all applicable reductions, including but not limited to the items identified in subparagraph (vi) of this paragraph.

(b)  For the purpose of calculating timeline requirements in this chapter in the event of multiple notices, the "final notice before extraordinary collection action" means the notice that first supplied the information required by paragraph (a) of this subsection if such information did not change in any subsequent notices.

(5)  "Health care facility" means any person, entity, or institution operating a physical or virtual location that holds itself out to the public as providing health care services through itself, through its employees, or through third-party health care providers. Health care facilities include but are not limited to hospitals and other licensed inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; urgent care centers; diagnostic, laboratory, and imaging centers; and rehabilitation and other therapeutic health settings, as well as medical transportation providers.

(6)  "Health care provider" means:

(a)  A physician or other health care practitioner licensed, accredited, or certified to perform health care services consistent with state law, or any agent or third-party representative thereof; or

(b)  A health care facility or its agent.

(7)  "Health care services" means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

(8)  "Patient" means a person who seeks or receives services from a health care provider. For the purposes of this chapter, "patient" includes a parent if the patient is a minor, a legal guardian if the patient is an adult under guardianship, or any person contractually or otherwise liable for the financial obligations of the person receiving goods or services from the health care provider.

(9)  "Third-party payor" means a health carrier as defined in section 41-5903, Idaho Code, or a self-funded plan as defined in section 41-4002 or 41-4102, Idaho Code, and includes multiple third-party payors when applicable.

(10) "Uncontested judgment" means a court judgment sought by one (1) party that is not contested by another party by filing with the court or by presenting evidence or argument at a hearing before the court.

History:

[48-303, added 2020, ch. 139, sec. 1, p. 426; am. 2022, ch. 263, sec. 1, p. 844.]