The Idaho Patient Act (IPA) and related laws govern medical billing practices in Idaho. Here are the detailed guidelines and laws:Key Requirements

1. Submission of Charges:
   • Health care providers must submit charges to the patient or the patient’s insurance company within 45 days of providing services or the date of discharge from the hospital.
   • If no insurance information is available, the claim must be sent to the patient. Missing this deadline limits the ability to recover costs and fees.
2. Consolidated Statement of Services:
   • Within 60 days of providing services, the patient must receive a consolidated statement of services that includes:
     • Patient name and contact information
     • Health care facility name and contact information
     • Date and duration of the patient’s visit
     • General description of the goods and services provided
     • List of billing entities and their contact information
     • A clear and conspicuous notification stating "This Is Not a Bill".
   • The statement can be emailed if the patient has given permission, or it can be handed to the patient in person. If mailed, it must be sent within 57 days of providing services, and the statute presumes it is received three days after mailing.
3. Final Statement:
   • The health care facility must send the patient a final statement that includes:
     • Patient and health care facility name and contact information
     • List of goods and services provided
     • Initial charges
     • Statement that a full itemized list is available upon request
     • Third-party payors and their contact information
     • Detailed description of reductions, adjustments, offsets, and payments received
     • Final amount the patient is liable to pay.
   • There is no specific timeline for sending the final statement, but interest and fees cannot be charged until 60 days after the patient receives it, and extraordinary collection actions cannot be pursued until 90 days after the patient receives it and all appeals, internal reviews, and good faith disputes have been resolved.

Extraordinary Collection Actions and Attorney Fees

1. Attorney Fees:
   • Attorneys’ fees are generally capped at $350 for an uncontested judgment and $750 for a contested judgment. Health care facilities can appeal if the amount awarded is grossly disproportionate to their costs and the patient is then awarded supplemental costs, expenses, and reasonable attorney’s fees.
2. Penalties for Non-Compliance:
   • If a medical provider is found to have willfully or knowingly violated the statute, the court can award up to three times the amount of the patient’s actual damages or $3,000, whichever is greater, plus the patient’s costs and reasonable attorney’s fees.

Additional Requirements

1. Confirm Patient Information:
   • Confirm the patient’s insurance information and contact information at every visit.
2. Documenting Statements:
   • Document when and how all statements are sent, and obtain patient signatures acknowledging receipt if delivered in person.

Recent Amendments

1. Extension for Pre-July 1, 2021 Services:
   • Due to the COVID-19 pandemic, medical providers can pursue extraordinary collection actions even if they did not meet the timing requirements for services provided before July 1, 2021. This extension is only applicable for services provided before July 1, 2021.

No Surprises Act

1. Protection from Unexpected Medical Bills:
   • The No Surprises Act provides protections for certain unexpected or excessive medical bills. Effective January 1, 2022, it ensures that consumers are not surprised by unexpected medical bills for emergency services or non-emergency services received from out-of-network providers.

These guidelines and laws aim to improve transparency and fairness in medical billing practices in Idaho, ensuring that patients are better informed and protected from excessive medical debt collection fees.