Fair Healthcare Billing Act of 2001

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Highlights:

  • Every contract between a physician and an health insurer shall be in writing and shall state the obligations of the parties with respect to charges and fees for services covered under that plan when provided by that physician to enrollees under that plan.
  • If the physician signs a contract in which he/she agrees not to balance bill the patient, the physician may not balance bill the patient.
  • Violation of either of the above provisions constitutes a violation of the Fair Healthcare Billing Act.

Ancillary Provisions:

  • A physician’s failure to inform the patient within 14 days that the physician has received the results of a laboratory test shall constitute grounds for disciplinary action by the Medical Board. Dates that laboratory test results are received and attempts to contact patients shall be documented in the patient record.

Key Provisions of the Fair Health Care Billing Act:

  • Any person who suffers injury or damages as a result of a violation may seek equitable relief (injunction) as well as general damages. Exemplary (treble) damages may be awarded in cases in which the Defendant has intentionally breached the law after actual notice.
  • Written demand for relief required 30 days before filing action. Defendant may tender a written offer of settlement within that 30 days. If the offer of settlement is rejected, damages may be limited to the amount of the offer if judge deems offer reasonable.
  • Governor’s Office of Consumer Affairs administers the Act. Authority to investigate and issue subpoenas through Attorney General, conduct hearing, issue cease and desist orders. Issue civil penalties of up to $2,000 for willful violation ($5,000 if application is made to Superior Court for issuance of such order).
  • Two-year statute of limitations.