C.R.S.
Section 25-49-106
Required disclosure to self-pay recipients
- estimate of total cost of health-care services upon request
- deceptive trade practice
- definition
(1)
Intentionally left blank —Ed.(a)
Upon the request of a person seeking a health-care service who intends to self-pay for the service, designated billing or patient services personnel representing a health-care provider or a health-care facility shall provide, prior to the provision of the health-care service, a self-pay estimate, pursuant to subsection (3) of this section, of the total estimated cost to the recipient of the anticipated health-care service, except as prohibited by 42 U.S.C. sec. 1395dd.(b)
Intentionally left blank —Ed.(I)
Except as provided in subsection (1)(b)(II) of this section, the final cost of the health-care service for which the self-pay estimate was made must be no more than fifteen percent higher than the total estimated cost indicated in the self-pay estimate or four hundred dollars, whichever is less.(II)
The final cost of the health-care service for which the self-pay estimate was made may be more than fifteen percent higher than the self-pay estimate or four hundred dollars if a medical emergency occurs that is associated with the health-care service or if an additional, unforeseen, medically necessary health-care service is required during the provision of the health-care service. The health-care provider or health-care facility shall make all reasonable efforts to obtain the consent of the recipient or, if the recipient is incapacitated, the recipient’s authorized agent prior to providing any emergency or unforeseen, medically necessary health-care service that will increase by more than fifteen percent the total cost indicated in the self-pay estimate or four hundred dollars, whichever is less.(2)
The right of a person to request a self-pay estimate prior to the receipt of a health-care service must be clearly and conspicuously stated by the health-care provider and posted at the health-care facility in a manner, in a location, and at a time reasonably calculated to inform the person of the right.(3)
The self-pay estimate must:(a)
Be in writing or, if the health-care provider or health-care facility is unable to provide a written self-pay estimate, the self-pay estimate and the following information must be stated in a recorded telephone call:(I)
The date and time of the telephone call;(II)
The telephone number of the consumer receiving the self-pay estimate;(III)
The manner in which consent for the self-pay estimate amount must be provided by the intended recipient;(IV)
The name of the intended recipient of the health-care service;(V)
The name of the health-care provider or health-care facility employee providing the self-pay estimate; and(VI)
Any other information material to the determination of the self-pay estimate;(b)
Include the total estimated cost of the health-care service, including an itemization of all necessary components of the service, which components may include a facility fee and the cost of personnel, imaging, medical tools or devices, and medicine;(c)
Be easy to understand by a person without knowledge of medical or technical jargon and with limited proficiency in math, science, and written and oral communication skills;(d)
Be provided in English or Spanish, if requested by the consumer; and(e)
Be provided within the following time frames:(I)
Not later than one business day after the date the primary item or service is scheduled if a primary item or service is scheduled at least three days before the primary item or service is provided;(II)
Not later than three business days after the date the primary item or service is scheduled if the primary item or service is scheduled at least ten business days before the primary item or service is provided; or(III)
Not later than three days after a request for a self-pay estimate.(4)
A provider or health-care facility that is in compliance with section 112 of Title I of division BB of the federal “No Surprises Act”, and rules promulgated and determined by the federal centers for medicare and medicaid services under that act in 45 CFR 149.610, or any successor laws and regulations, is in compliance with this section.(5)
A violation of this section is a deceptive trade practice pursuant to section 6-1-105 (1)(yyy).(6)
As used in this section, “federal ’No Surprises Act’” means the federal “No Surprises Act”, Pub.L. 116-260, as amended.
Source:
Section 25-49-106 — Required disclosure to self-pay recipients - estimate of total cost of health-care services upon request - deceptive trade practice - definition, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.pdf (accessed Oct. 20, 2023).
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