V.T.C.A. Occupations Code § 101.352

Billing Policies and Information; Physicians

A physician must establish and maintain policies for billing of health care services.  The policies must address:

• Discounts of charges to uninsured individuals;
• Discounting of charges to indigent consumers who qualify for indigent services on sliding scale or other written charity care policy;
• Whether interest will apply to services not covered by a third party payer, and the interest rate;
• Complaint procedure.

All such policies must be posted conspicuously in the waiting area, business office, or admission areas. 

Physicians must provide an estimate for patients seeking services on an out of network basis or do not have coverage under a government program upon the patient’s request.  The estimate must be provided within 10 business days of the request.  The physician must also advise the patient that:

• The request for an estimate may result in a delay in scheduling the procedure;
• The actual charges for the procedure may vary based on the person’s medical condition and other factors;
• The actual charges for the procedure may be different than what is actually paid by the consumer or his or her third party payer;
• The consumer may be personally liable for payment for the procedure depending on his or her health plan coverage.

For emergency department admissions or direct emergent admissions, the physician must provide an estimate of charges within 10 business days after the request or before discharging the patient from the emergency room, whichever is later. 

The physician must provide an itemized statement of billed services upon a consumer’s request within 10 business days.  However, this applies if the consumer makes the request within 1 year from the date of the service.  If a patient requests more than 2 copies of the statement, a physician may charge a reasonable fee for the 3^rd and subsequent copies. 

A physician must provide a written explanation of the charges for services in plain language, upon the patient’s request. 

If a consumer overpays the physician, the physician must return the overpayment within 30 days of determining that an overpayment has been made.