2009 Texas Code
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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