State Codes and Statutes
Statutes > Texas > Civil-practice-and-remedies-code > Title-6-miscellaneous-provisions > Chapter-146-certain-claims-by-health-care-service-providers-barred
CIVIL PRACTICE AND REMEDIES CODE
TITLE 6. MISCELLANEOUS PROVISIONS
CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS
BARRED
Sec. 146.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a plan or arrangement under
which medical or surgical expenses are paid for or reimbursed or
health care services are arranged for or provided. The term
includes:
(A) an individual, group, blanket, or franchise insurance
policy, insurance agreement, or group hospital service contract;
(B) an evidence of coverage or group subscriber contract issued
by a health maintenance organization or an approved nonprofit
health corporation;
(C) a benefit plan provided by a multiple employer welfare
arrangement or another analogous benefit arrangement;
(D) a workers' compensation insurance policy; or
(E) a motor vehicle insurance policy, to the extent the policy
provides personal injury protection or medical payments coverage.
(2) "Health care service provider" means a person who, under a
license or other grant of authority issued by this state,
provides health care services the costs of which may be paid for
or reimbursed under a health benefit plan.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.002. TIMELY BILLING REQUIRED. (a) Except as provided
by Subsection (b) or (c), a health care service provider shall
bill a patient or other responsible person for services provided
to the patient not later than the first day of the 11th month
after the date the services are provided.
(b) If the health care service provider is required or
authorized to directly bill the issuer of a health benefit plan
for services provided to a patient, the health care service
provider shall bill the issuer of the plan not later than:
(1) the date required under any contract between the health care
service provider and the issuer of the health benefit plan; or
(2) if there is no contract between the health care service
provider and the issuer of the health benefit plan, the first day
of the 11th month after the date the services are provided.
(c) If the health care service provider is required or
authorized to directly bill a third party payor operating under
federal or state law, including Medicare and the state Medicaid
program, the health care service provider shall bill the third
party payor not later than:
(1) the date required under any contract between the health care
service provider and the third party payor or the date required
by federal regulation or state rule, as applicable; or
(2) if there is no contract between the health care service
provider and the third party payor and there is no applicable
federal regulation or state rule, the first day of the 11th month
after the date the services are provided.
(d) For purposes of this section, the date of billing is the
date on which the health care service provider's bill is:
(1) mailed to the patient or responsible person, postage
prepaid, at the address of the patient or responsible person as
shown on the health care service provider's records; or
(2) mailed or otherwise submitted to the issuer of the health
benefit plan or third party payor as required by the health
benefit plan or third party payor.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.003. CERTAIN CLAIMS BARRED. (a) A health care service
provider who violates Section 146.002 may not recover from the
patient any amount that the patient would have been entitled to
receive as payment or reimbursement under a health benefit plan
or that the patient would not otherwise have been obligated to
pay had the provider complied with Section 146.002.
(b) If recovery from a patient is barred under this section, the
health care service provider may not recover from any other
individual who, because of a family or other personal
relationship with the patient, would otherwise be responsible for
the debt.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. A health care
service provider who violates this chapter is not subject to
disciplinary action for the violation under any other law,
including the law under which the health care service provider is
licensed or otherwise holds a grant of authority.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
State Codes and Statutes
Statutes > Texas > Civil-practice-and-remedies-code > Title-6-miscellaneous-provisions > Chapter-146-certain-claims-by-health-care-service-providers-barred
CIVIL PRACTICE AND REMEDIES CODE
TITLE 6. MISCELLANEOUS PROVISIONS
CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS
BARRED
Sec. 146.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a plan or arrangement under
which medical or surgical expenses are paid for or reimbursed or
health care services are arranged for or provided. The term
includes:
(A) an individual, group, blanket, or franchise insurance
policy, insurance agreement, or group hospital service contract;
(B) an evidence of coverage or group subscriber contract issued
by a health maintenance organization or an approved nonprofit
health corporation;
(C) a benefit plan provided by a multiple employer welfare
arrangement or another analogous benefit arrangement;
(D) a workers' compensation insurance policy; or
(E) a motor vehicle insurance policy, to the extent the policy
provides personal injury protection or medical payments coverage.
(2) "Health care service provider" means a person who, under a
license or other grant of authority issued by this state,
provides health care services the costs of which may be paid for
or reimbursed under a health benefit plan.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.002. TIMELY BILLING REQUIRED. (a) Except as provided
by Subsection (b) or (c), a health care service provider shall
bill a patient or other responsible person for services provided
to the patient not later than the first day of the 11th month
after the date the services are provided.
(b) If the health care service provider is required or
authorized to directly bill the issuer of a health benefit plan
for services provided to a patient, the health care service
provider shall bill the issuer of the plan not later than:
(1) the date required under any contract between the health care
service provider and the issuer of the health benefit plan; or
(2) if there is no contract between the health care service
provider and the issuer of the health benefit plan, the first day
of the 11th month after the date the services are provided.
(c) If the health care service provider is required or
authorized to directly bill a third party payor operating under
federal or state law, including Medicare and the state Medicaid
program, the health care service provider shall bill the third
party payor not later than:
(1) the date required under any contract between the health care
service provider and the third party payor or the date required
by federal regulation or state rule, as applicable; or
(2) if there is no contract between the health care service
provider and the third party payor and there is no applicable
federal regulation or state rule, the first day of the 11th month
after the date the services are provided.
(d) For purposes of this section, the date of billing is the
date on which the health care service provider's bill is:
(1) mailed to the patient or responsible person, postage
prepaid, at the address of the patient or responsible person as
shown on the health care service provider's records; or
(2) mailed or otherwise submitted to the issuer of the health
benefit plan or third party payor as required by the health
benefit plan or third party payor.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.003. CERTAIN CLAIMS BARRED. (a) A health care service
provider who violates Section 146.002 may not recover from the
patient any amount that the patient would have been entitled to
receive as payment or reimbursement under a health benefit plan
or that the patient would not otherwise have been obligated to
pay had the provider complied with Section 146.002.
(b) If recovery from a patient is barred under this section, the
health care service provider may not recover from any other
individual who, because of a family or other personal
relationship with the patient, would otherwise be responsible for
the debt.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. A health care
service provider who violates this chapter is not subject to
disciplinary action for the violation under any other law,
including the law under which the health care service provider is
licensed or otherwise holds a grant of authority.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
State Codes and Statutes
Statutes >
Texas >
Civil-practice-and-remedies-code >
Title-6-miscellaneous-provisions >
Chapter-146-certain-claims-by-health-care-service-providers-barred CIVIL PRACTICE AND REMEDIES CODE
TITLE 6. MISCELLANEOUS PROVISIONS
CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS
BARRED
Sec. 146.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a plan or arrangement under
which medical or surgical expenses are paid for or reimbursed or
health care services are arranged for or provided. The term
includes:
(A) an individual, group, blanket, or franchise insurance
policy, insurance agreement, or group hospital service contract;
(B) an evidence of coverage or group subscriber contract issued
by a health maintenance organization or an approved nonprofit
health corporation;
(C) a benefit plan provided by a multiple employer welfare
arrangement or another analogous benefit arrangement;
(D) a workers' compensation insurance policy; or
(E) a motor vehicle insurance policy, to the extent the policy
provides personal injury protection or medical payments coverage.
(2) "Health care service provider" means a person who, under a
license or other grant of authority issued by this state,
provides health care services the costs of which may be paid for
or reimbursed under a health benefit plan.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.002. TIMELY BILLING REQUIRED. (a) Except as provided
by Subsection (b) or (c), a health care service provider shall
bill a patient or other responsible person for services provided
to the patient not later than the first day of the 11th month
after the date the services are provided.
(b) If the health care service provider is required or
authorized to directly bill the issuer of a health benefit plan
for services provided to a patient, the health care service
provider shall bill the issuer of the plan not later than:
(1) the date required under any contract between the health care
service provider and the issuer of the health benefit plan; or
(2) if there is no contract between the health care service
provider and the issuer of the health benefit plan, the first day
of the 11th month after the date the services are provided.
(c) If the health care service provider is required or
authorized to directly bill a third party payor operating under
federal or state law, including Medicare and the state Medicaid
program, the health care service provider shall bill the third
party payor not later than:
(1) the date required under any contract between the health care
service provider and the third party payor or the date required
by federal regulation or state rule, as applicable; or
(2) if there is no contract between the health care service
provider and the third party payor and there is no applicable
federal regulation or state rule, the first day of the 11th month
after the date the services are provided.
(d) For purposes of this section, the date of billing is the
date on which the health care service provider's bill is:
(1) mailed to the patient or responsible person, postage
prepaid, at the address of the patient or responsible person as
shown on the health care service provider's records; or
(2) mailed or otherwise submitted to the issuer of the health
benefit plan or third party payor as required by the health
benefit plan or third party payor.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.003. CERTAIN CLAIMS BARRED. (a) A health care service
provider who violates Section 146.002 may not recover from the
patient any amount that the patient would have been entitled to
receive as payment or reimbursement under a health benefit plan
or that the patient would not otherwise have been obligated to
pay had the provider complied with Section 146.002.
(b) If recovery from a patient is barred under this section, the
health care service provider may not recover from any other
individual who, because of a family or other personal
relationship with the patient, would otherwise be responsible for
the debt.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. A health care
service provider who violates this chapter is not subject to
disciplinary action for the violation under any other law,
including the law under which the health care service provider is
licensed or otherwise holds a grant of authority.
Added by Acts 1999, 76th Leg., ch. 650, Sec. 1, eff. Sept. 1,
1999.
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