C.R.S. Section 18-13-119
Health-care providers

  • abuse of health insurance

(1)

The general assembly hereby finds, determines, and declares that:

(a)

Business practices that have the effect of eliminating the need for actual payment by the recipient of health care of required copayments and deductibles in health benefit plans interfere with contractual obligations entered into between the insured and the insurer relating to such payments;

(b)

Such interference is not in the public interest when it is conducted as a regular business practice because it has the effect of increasing health-care costs by removing the incentive that copayments and deductibles create in making the consumer a cost-conscious purchaser of health care; and

(c)

Advertising of such practices may aggravate the adverse financial and other impacts upon recipients of health care.

(2)

Therefore, the general assembly declares that such business practices are illegal and that violation thereof or the advertising thereof shall be grounds for disciplinary actions. The general assembly further declares that nothing contained in this section shall be construed to otherwise prohibit advertising by health-care providers.

(3)

Except as otherwise provided in subsections (5), (6), and (8) of this section, if the effect is to eliminate the need for payment by the patient of any required deductible or copayment applicable in the patient’s health benefit plan, a person who provides health care commits abuse of health insurance if the person knowingly:

(a)

Accepts from any third-party payer, as payment in full for services rendered, the amount the third-party payer covers; or

(b)

Submits a fee to a third-party payer which is higher than the fee he has agreed to accept from the insured patient with the understanding of waiving the required deductible or copayment.

(4)

Abuse of health insurance is a petty offense.

(5)

Intentionally left blank —Ed.

(a)

Reimbursements made pursuant to articles 3 to 6 of title 25.5, C.R.S., federal medicare laws for inpatient hospitalization, and mental health services purchased in accordance with article 66 of title 27, C.R.S., are exempt from the provisions of this section.

(b)

Health-care services are exempt from the provisions of this section if such health-care services are provided:

(I)

In accordance with a contract or agreement between an employer and an employee or employees and the contract includes, as a part of an employee’s salary or employment benefits, terms that authorize a practice that would otherwise be prohibited by subsection (3) of this section; or

(II)

In accordance with a contract or agreement between a town, city, city and county, or municipality or a special health assurance district pursuant to section 31-15-302 (1), C.R.S., under terms that authorize a practice that would otherwise be prohibited by subsection (3) of this section.

(6)

Intentionally left blank —Ed.

(a)

The waiver of any required deductible or copayment for charitable purposes is exempt from the provisions of subsection (3) of this section if:

(I)

The person who provides the health care determines that the services are necessary for the immediate health and welfare of the patient; and

(II)

The waiver is made on a case-by-case basis and the person who provides the health care determines that payment of the deductible or copayment would create a substantial financial hardship for the patient; and

(III)

The waiver is not a regular business practice of the person who provides the health care.

(b)

Any person who provides health care and who waives the deductible or copayment for more than one-fourth of his patients during any calendar year, excluding patients covered by subsection (5) of this section, or who advertises through newspapers, magazines, circulars, direct mail, directories, radio, television, or otherwise that he will accept from any third-party payer, as payment in full for services rendered, the amount the third-party payer covers shall be presumed to be engaged in waiving the deductible or copayment as a regular business practice.

(7)

Repealed.

(8)

The waiver of a required deductible or copayment for health-care services provided by a school-based health center, as defined in section 25-20.5-502, C.R.S., is exempt from the provisions of this section.

Source: Section 18-13-119 — Health-care providers - abuse of health insurance, https://leg.­colorado.­gov/sites/default/files/images/olls/crs2023-title-18.­pdf (accessed Oct. 20, 2023).

18‑13‑101
Abuse of a corpse 18‑13‑104
Fighting by agreement - dueling 18‑13‑106
Unlawful to discard or abandon iceboxes or motor vehicles and similar items 18‑13‑107
Interference with persons with disabilities 18‑13‑107.3
Intentional misrepresentation of entitlement to an assistance animal - penalty - definitions 18‑13‑107.7
Intentional misrepresentation of a service animal for a person with a disability - penalty - definitions 18‑13‑108
Removal of timber from state lands 18‑13‑109
Firing woods or prairie 18‑13‑109.5
Intentionally setting wildfire 18‑13‑111
Purchases of commodity metals or detached catalytic converters - violations - commodity metals theft task force - creation - composition - reports - legislative declaration - definitions - repeal 18‑13‑112
Hazardous waste violations 18‑13‑113
Unlawful to sell metal beverage containers with detachable opening devices 18‑13‑114
Sale of secondhand property - record - inspection - crime - definitions 18‑13‑114.5
Proof of ownership required - penalty - definitions 18‑13‑115
Notice - penalties 18‑13‑116
Sales tax license 18‑13‑117
Record of sales 18‑13‑118
Regulation of secondhand dealers 18‑13‑119
Health-care providers - abuse of health insurance 18‑13‑119.5
Abuse of property insurance 18‑13‑120
Use, transportation, and storage of drip gasoline 18‑13‑121
Furnishing cigarettes, tobacco products, or nicotine products to persons under twenty-one years of age 18‑13‑122
Illegal possession or consumption of ethyl alcohol or marijuana by an underage person - illegal possession of marijuana paraphernalia by an underage person - adolescent substance abuse prevention and treatment fund - legislative declaration - definitions 18‑13‑123
Unlawful administration of gamma hydroxybutyrate (GHB) or ketamine 18‑13‑124
Dissemination of false information to obtain hospital admittance or care 18‑13‑125
Telephone records - sale or purchase 18‑13‑126
Locating protected persons 18‑13‑130
Bail bond - prohibited activities - penalties 18‑13‑131
Misuse of gametes - definitions 18‑13‑132
Furnishing kratom products to persons under twenty-one years of age 18‑13‑133
Prohibition on prosecuting health-care providers - patient ingests abortifacient in another state
Green check means up to date. Up to date

Current through Fall 2024

§ 18-13-119’s source at colorado​.gov