As used in this article 49, unless the context
otherwise requires:
(1)Agency means a government department or agency or a government-created entity.
(2)CPT code means the current procedural terminology code, or its
successor code, as developed and copyrighted by the American Medical
Association or its successor entity.
(3)Health-care facility means a facility licensed or certified by the
department of public health and environment pursuant to section 25-1.5-103. The
term does not include a nursing care facility, assisted living residence, or home care
agency.
(4)(a) Health-care price means the price, before negotiating any discounts,
that a health-care provider or health-care facility will charge a recipient for health-care services that will be rendered. Health-care price i
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As used in this article 49, unless the context
otherwise requires:
(1) Agency means a government department or agency or a government-created entity.
(2) CPT code means the current procedural terminology code, or its
successor code, as developed and copyrighted by the American Medical
Association or its successor entity.
(3) Health-care facility means a facility licensed or certified by the
department of public health and environment pursuant to section 25-1.5-103. The
term does not include a nursing care facility, assisted living residence, or home care
agency.
(4) (a) Health-care price means the price, before negotiating any discounts,
that a health-care provider or health-care facility will charge a recipient for health-care services that will be rendered. Health-care price is the price charged for the
standard service for the particular diagnosis and does not include any amount that
may be charged for complications or exceptional treatment. The health-care price
for a specific health-care service may be determined from any of the following:
(I) The price charged most frequently for the health-care service during the
previous twelve months;
(II) The highest charge from the lowest half of all charges for the health-care
service during the previous twelve months; or
(III) A range that includes the middle fifty percent of all charges for the
health- care service during the previous twelve months.
(b) Health-care price does not mean the amount charged if a public or
private third party will be paying or reimbursing the health-care provider or health-care facility for any portion of the cost of services rendered.
(5) Health-care provider means a person who is licensed, certified, or
registered by this state to provide health-care services or a medical group,
independent practice association, or professional corporation providing health-care
services.
(6) (a) Health-care services or services means services included in, or
incidental to, furnishing to an individual:
(I) Medical, mental, dental, or optometric care or hospitalization; or
(II) Other services for the purpose of preventing, alleviating, curing, or
healing a physical illness, an injury, or a mental health disorder.
(b) Health-care services includes services rendered through the use of
telemedicine.
(7) Health insurer means a carrier, as defined in section 10-16-102 (8),
disability insurer, group disability insurer, or blanket disability insurer.
(8) (a) Public or private third party means a health insurer, self-insured
employer, or other third party, including a third-party administrator or intermediary,
responsible for paying all or a portion of the charges for health-care services.
(b) Public or private third party does not mean:
(I) An employer of the recipient of the health-care services that is not
responsible for paying the charges for the health-care services provided to the
recipient;
(II) A person paying money from a health savings account, flexible spending
account, or similar account; or
(III) A family member, charitable organization, or other person who is not
responsible for, but pays charges for, health-care services on behalf of the
recipient of the services.
(9) Punish means to impose a penalty, surcharge, fee, or other additional
cost or measure that has the same effect as a penalty or that discourages the
exercise of rights under this article 49.
(10) Recipient means an individual who receives health-care services from
a health-care provider or health-care facility.
(11) Self-pay means payment without the assistance of a public or private
third party.