Utah Code 31A-26-313. Health care collection actions — Notification required
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(1) As used in this section:
Terms Used In Utah Code 31A-26-313
- Agency: means :(6)(a) a person other than an individual, including a sole proprietorship by which an individual does business under an assumed name; and(6)(b) an insurance organization licensed or required to be licensed under Section
31A-23a-301 ,31A-25-207 , or31A-26-209 . See Utah Code 31A-1-301- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Contract: A legal written agreement that becomes binding when signed.
- Credit bureau: An agency that collects individual credit information and sells it for a fee to creditors so they can make a decision on granting loans. Typical clients include banks, mortgage lenders, credit card companies, and other financing companies. (Also commonly referred to as consumer-reporting agency or credit-reporting agency.) Source: OCC
- Credit Score: A number, roughly between 300 and 800, that measures an individual's credit worthiness. The most well-known type of credit score is the FICO score. This score represents the answer from a mathematical formula that assigns numerical values to various pieces of information in your credit report. Source: OCC
- Health care: means any of the following intended for use in the diagnosis, treatment, mitigation, or prevention of a human ailment or impairment:
(83)(a) a professional service;(83)(b) a personal service;(83)(c) a facility;(83)(d) equipment;(83)(e) a device;(83)(f) supplies; or(83)(g) medicine. See Utah Code 31A-1-301- Health care provider: means the same as that term is defined in Section
78B-3-403 . See Utah Code 31A-1-301- Insured: means a person to whom or for whose benefit an insurer makes a promise in an insurance policy and includes:
(103)(a)(i) a policyholder;(103)(a)(ii) a subscriber;(103)(a)(iii) a member; and(103)(a)(iv) a beneficiary. See Utah Code 31A-1-301- Medicare: means the "Health Insurance for the Aged Act" Title XVIII of the federal Social Security Act, as then constituted or later amended. See Utah Code 31A-1-301
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(1)(a)(1)(a)(i) “Collection action” means any action taken to recover funds that are past due or accounts that are in default:(1)(a)(i)(A) for health care services; and(1)(a)(i)(B) that directly results in an adverse report to a credit bureau.(1)(a)(ii) “Collection action” includes using the services of a collection agency to engage in collection action.(1)(a)(iii) “Collection action” does not include:(1)(a)(iii)(A) billing or invoicing for funds that are not past due or accounts that are not in default; or(1)(a)(iii)(B) providing the notice required in this section.(1)(b) “Credit bureau” means a consumer reporting agency as defined in 15 U.S.C. § 1681a.(1)(c) “Text message” means a real time or near real time message that consists of text and is transmitted to a device identified by a telephone number.(2)(2)(a) Before engaging in a collection action, a health care provider:(2)(a)(i) shall, after the day on which the period of time for an insurer to pay or deny a claim without penalty, described in Section 31A-26-301.6, expires, send a notice described in Subsection (3) to the insured by certified mail with return receipt requested, priority mail, first class mail, email, or text message; and(2)(a)(ii) for a Medicare beneficiary or retiree 65 years of age or older, shall, after the date that Medicare determines Medicare’s liability for the claim, send a notice described in Subsection (3) to the insured by certified mail with return receipt requested, priority mail, first class mail, or text message.(2)(b) A health care provider may not engage in a collection action before the date described in Subsection (3)(b) for that collection action.(3) The notice described in Subsection (2)(a) shall state:(3)(a) the amount that the insured owes;(3)(b) the date by which the insured must pay the amount owed that is:(3)(b)(i) at least 45 days after the day on which the health care provider sends the notice; or(3)(b)(ii) if the insured is a Medicare beneficiary or retiree 65 years of age or older, at least 60 days after the day on which the health care provider sends the notice;(3)(c) that if the insured fails to timely pay the amount owed, the health care provider or a third party may make a report to a credit bureau or use the services of a collection agency; and(3)(d) that each action described in Subsection (3)(c) may negatively impact the insured’s credit score.(4) A health care provider is not subject to the requirements described in Subsection (2) if the health care provider complies with the provisions of 26 C.F.R. § 1.501(r)-6.(5) A health care provider that contracts with a third party to engage in a collection action is not subject to the requirements described in Subsection (2) if:(5)(a) entering into the contract does not require a report to a credit bureau by either the health care provider or the third party; and(5)(b) the third party agrees to provide the notice in accordance with Subsection (2) before the third party may engage in any activity that directly results in a report to a credit bureau.(6) If a third party fails to comply with the notice requirements described in this section, the health care provider that renders the health care service is liable for any penalty resulting from the noncompliance of the third party.