31A-26-301.5. Health care claims practices.

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A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/8/2018

(a)Except as provided in Section 31A-8-407 , an insured retains ultimate responsibility for paying for health care services the insured receives.

(b)If a health care service is covered by one or more individual or group health insurance policies, all insurers covering the insured have the responsibility to pay valid health care claims in a timely manner according to the terms and limits specified in the policies.

(2)A health care provider may:

(a)except as provided in Section 31A-22-610.1 , bill and collect for any deductible, copayment, or uncovered service; and

(b)bill an insured for services covered by health insurance policies or otherwise notify the insured of the expenses covered by the policies.

(3)Beginning October 31, 1992, all insurers covering the insured shall notify the insured of payment and the amount of payment made to the health care provider.

(4)A health care provider shall return to an insured any amount the insured overpaid, including interest that begins accruing 90 days after the date of the overpayment, if:

(a)the insured has multiple insurers with whom the health care provider has contracts that cover the insured; and

(b)the health care provider becomes aware that the health care provider has received, for any reason, payment for a claim in an amount greater than the health care provider's contracted rate allows.

(a)The commissioner shall make rules consistent with this chapter governing disclosure to the insured of customary charges by health care providers on the explanation of benefits as part of the claims payment process.

(b)These rules shall be limited to the form and content of the disclosures on the explanation of benefits, and shall include:

(i)a requirement that the method of determination of any specifically referenced customary charges and the range of the customary charges be disclosed; and

(ii)a prohibition against an implication that the health care provider is charging excessively if the health care provider is:

(A)a participating provider; and

(B)prohibited from balance billing.

Amended by Chapter 203 , 2018 General Session