2018 Arkansas Code
Title 23 - Public Utilities and Regulated Industries
Subtitle 3 - Insurance
Chapter 63 - Insurance Companies Generally
Subchapter 18 - Audits of Medical Providers
§ 23-63-1801. Definitions
- As used in this subchapter:
(1) "Covered person" means a person on whose behalf a health care insurer offering health insurance coverage is obligated to pay benefits or provide services;
(2) "Health care insurer" means an entity subject to the insurance laws of this state or the jurisdiction of the Insurance Commissioner that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, or a hospital medical service corporation;
(3) "Health care provider" means any person or entity providing:
(A) Medical, pharmaceutical, optometric, or dental care;
(B) Hospitalization; or
(C) Any other services and goods used for the purpose or incidental to the purpose of preventing, alleviating, curing, or healing human illness or injury;
(4)
(A) "Health insurance coverage" means benefits consisting of medical, pharmaceutical, optometric, or dental care, hospitalization, or other goods or services for the purpose of preventing, alleviating, curing, or healing human illness provided, directly or indirectly, through insurance, reimbursement, or otherwise, including items and services paid for under any policy, certificate, or agreement offered by a health care insurer.
(B) "Health insurance coverage" does not include policies or certificates covering only accident, credit, disability income, long-term care, hospital indemnity, Medicare supplemental policy as defined in 42 U.S.C. § 1395ss(g)(1), a specified disease, other limited benefit health insurance, automobile medical payment insurance, or claims under the Workers' Compensation Law, § 11-9-101 et seq., Public Employee Workers' Compensation Act, § 21-5-601 et seq., or the Comprehensive Health Insurance Pool Act, § 23-79-501 et seq.; and
(5) "Recoupment" means any action or attempt by a health care insurer to recover or collect payments already made to a health care provider with respect to a claim:
(A) By reducing other payments currently owed to the health care provider;
(B) By withholding or setting off the amount against current or future payments to the health care provider;
(C) By demanding payment back from a health care provider for a claim already paid; or
(D) By any other manner that reduces or affects the future claim payments to the health care provider.
