W. Va. Code R. § 4-1-9

Current through Register Vol. XLI, No. 50, December 13, 2024
Section 4-1-9 - Pre-Payment Plans
1-9.3. Certain restrictions shall apply to billing practices involved in pre-payment plans.
1-9.3.a. The sole purpose behind pre-payment plans must be to provide, in good faith, an affordable healthcare plan to the patient. In offering a pre-payment plan, a chiropractor must, in good faith, explain to the patient the scope of the plan, the patient's rights and responsibilities under the plan, the cost of the plan, and the treatment that will be rendered under the plan.
1-9.3.b. Any contract for a pre-payment plan must contain, in writing, the following provisions:
1-9.3.b.1. The pre-payment plan must note the severity of pain from which the patient is suffering at the time the patient enters into the agreement;
1-9.3.b.2. There shall be a ten (10) day period during which the patient may withdraw from the pre-payment plan without penalty;
1-9.3.b.3. The pre-payment plan shall state specifically and unambiguously the total cost that the patient will incur under the plan, as well as an estimate of the total cost that the patient would have incurred had the patient sought treatment outside of a pre-payment plan;
1-9.3.b.4. The pre-payment plan shall specifically describe which chiropractic services are included in the plan and which services are excluded. This description shall include the time frame and the number of visits that are covered by the plan. The plan shall also identify how absences of care will be treated under the plan;
1-9.3.b.5. The pre-payment plan shall describe how other care shall be handled under the plan if the patient has a subsequent injuiy that is covered by insurance;
1-9.3.b.6. The pre-payment plan shall have a clear exit provision that identifies the circumstances under which the plan may be terminated and how any amounts owed for treatment rendered will be billed to the patient;
1-9.3.c. A signed copy of the pre-payment plan shall be maintained in the patient's treatment file.

W. Va. Code R. § 4-1-9