Many people have asked about the law regarding billing by doctors and hopsitals. Here is what it says.
TEXAS STATUTES AND CODES
CIVIL
PRACTICE AND REMEDIES CODE
TITLE 6. MISCELLANEOUS PROVISIONS
CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS BARRED
Tex. Civ. Prac. & Rem. Code § 146.001 (2000)
§ 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.
§
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.
§
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.