Colorado § 10-16-317.5 Assignment of benefits

Colorado Statutes

§ 10-16-317.5 — Assignment of benefits

Colorado § 10-16-317.5

Title 10Insurance

Art.Health-care Coverage

This text of Colorado § 10-16-317.5 (Assignment of benefits) is published on Counsel Stack Legal Research, covering Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Colo. Rev. Stat. § 10-16-317.5 (2026).

Text

(1)An individual or group nonprofit hospital or medical service contract issued pursuant to the provisions of this article shall not prohibit a subscriber under the contract from assigning, in writing, benefits payable under the contract to a licensed hospital or other licensed health-care provider for services provided to the subscriber which are covered under the contract.

(2)When a licensed hospital or other licensed health-care provider receives an assignment from a subscriber it is the responsibility of the provider to bill the contract issuer, including a copy of the assignment, and to mail a copy of such bill to the subscriber or certificate holder, stating on such copy that it is for informational purposes only and that the payer has been billed for covered benefits. Th

Free access — add to your briefcase to read the full text and ask questions with AI

(1) An individual or group nonprofit
hospital or medical service contract issued pursuant to the provisions of this article
shall not prohibit a subscriber under the contract from assigning, in writing,
benefits payable under the contract to a licensed hospital or other licensed health-care provider for services provided to the subscriber which are covered under the
contract.

(2) When a licensed hospital or other licensed health-care provider receives
an assignment from a subscriber it is the responsibility of the provider to bill the
contract issuer, including a copy of the assignment, and to mail a copy of such bill
to the subscriber or certificate holder, stating on such copy that it is for
informational purposes only and that the payer has been billed for covered benefits.
The issuer of such nonprofit hospital or medical service contract shall honor such
assignment and make payment of covered benefits directly to such licensed
hospital or other licensed health-care provider. In the event the issuer fails to honor
such assignment by making payment to the subscriber and the subscriber, upon
receipt of such payment, fails to timely pay an amount equivalent to such payment
to the licensed hospital or other licensed health-care provider, then the issuer shall
be liable for such covered benefits payment directly to the licensed hospital or
other licensed health-care provider. It shall be the responsibility of the licensed
hospital or other licensed health-care provider to notify the issuer if timely payment
has not been received. In such case, the issuer shall make payment of covered
benefits pursuant to section 10-3-1110 (2) within thirty days after receipt of such
notification.

(3) (a) Nothing in this section shall be construed to limit any nonprofit
hospital, medical-surgical, and health-care service corporation from determining
the scope of its benefits or services or any other terms of its subscriber contracts,
nor from negotiating contracts with licensed providers on reimbursement rates or
any other lawful provisions.

(b) Notwithstanding the provisions of subsection (2) of this section, a
licensed provider shall not be entitled to payment greater than the lesser of its
charges or any level of reimbursement previously negotiated with any nonprofit
hospital, medical-surgical, and health-care service corporation, if applicable; nor
shall such payer have any obligation under this section except for covered benefits.

(4) Nothing in this section shall be construed to prevent any nonprofit
hospital, medical-surgical, and health-care service corporation from limiting
covered benefits to services provided by providers who have contracted with such
corporation or from providing different levels of benefits depending on whether the
provider has or has not contracted with such corporation.