Wyoming Administrative Code
Agency 030 - Chiropractic Examiners, Board of
Sub-Agency 0001 - Chiropractic Examiners, Board of
Chapter 11 - CHIROPRACTIC PRACTICE
Section 11-6 - Prepaid Care Plans
Universal Citation: WY Code of Rules 11-6
Current through September 21, 2024
(a) Any arrangement or agreement between a licensee and a patient for a course of future treatment for which funds in an amount of five hundred dollars ($500.00) or more during any twelve (12) month period are collected in advance of these services shall be considered a prepaid care plan within the meaning of this section. Services under a prepaid care plan may cost less than if the services were purchased individually. The reduction in cost must bear a reasonable relationship to the expense avoided by the provider due to reduced accounting and debt collection activities. The prepaid care plan may provide for either an annual or monthly fee out of pocket. A licensee who offers such a plan is subject to the following requirements:
(i) Escrow account. A designated
escrow account insured by the Federal Deposit Insurance Corporation, state
bank, or credit union shall be established for deposit of all funds received in
connection with the prepaid care plan. Such funds may not be commingled with a
licensee's personal or business account.
(A)
All instruments, including checks and deposit slips, must bear the phrase
"Escrow Account."
(B) The licensee
shall maintain a clear accounting of all funds received, including date and
from whom the funds were received.
(C) The licensee shall maintain a clear
accounting of all disbursements including the dates and to whom the
disbursements were made, and to which patient the disbursements are to be
applied or accounted for.
(D) No
more than one escrow account is required regardless of the number of prepaid
plans maintained by the licensee.
(E) Funds may only be transferred out of the
escrow account for the following reasons:
(I)
After services, goods, or appliances have been provided to the patient, and
only in the usual and customary amounts specifically related to the services,
goods, or appliances provided;
(II)
To reimburse the patient any amounts owed following a notice by either the
patient or the licensee to terminate the prepaid plan. Any amounts must be
transferred according to the written agreement; or
(F) The licensee shall cause a reconciliation
of the escrow account to be made no less than quarterly, with a copy provided
to the patient, and shall retain a copy of the reconciliations and all
supporting documents for no less than seven (7) years.
(ii) Written plan. All prepaid care plans
require a written plan, signed by both the licensee and the patient, with a
copy maintained in the patient's record and a copy provided to the patient, and
must include at least the following:
(A) A
list of all services, goods, and appliances which are covered by the
plan.
(B) A list of all fees
related to the services described in the plan.
(C) A statement that an accounting can be
requested by the patient at any time. This accounting must:
(I) Be provided to the patient within five
(5) working days of a written or verbal request; and
(II) Itemize all fees used to calculate any
reimbursement.
(D) An
explanation of the reimbursement policies and formula that are used in
returning unused funds to the patient in the event of early termination by
either the chiropractor or the patient. The patient has the right to terminate
the prepaid care plan at any time without financial penalty.
(E) An explanation of any policy modifying
the plan in the event of an injury, such as an auto injury or work-related
injury or in the event of extended absence or new illness. These explanations
must be separately initialed by the patient.
(F) A provision that the patient will be
notified in writing when the patient's account reaches a zero
balance.
(G) A statement that
indicates the licensee makes no claim or representation that a particular
treatment, procedure, or service, or any combination of treatments, procedures,
or services, is guaranteed to result in a particular clinical
outcome.
(H) A statement that the
patient has the right to cancel the prepaid care plan without penalty within
three (3) business days of entering into the plan by submitting a written and
signed cancellation notice, and upon the licensee's receipt of the cancellation
notice, the licensee shall have seven (7) working days to fully refund any
unused funds to the patient. This right of cancellation may not be waived or
otherwise surrendered.
(iii) Early termination. The patient has the
right to terminate the prepaid care plan at any time without financial penalty.
The licensee may terminate the prepaid plan at any time, for good and
sufficient cause, except the licensee must ensure that patient abandonment does
not occur. In the event care is terminated, the patient's remaining funds shall
be reimbursed to the patient in full.
(iv) Prepaid care plans must be compliant
with all applicable state and federal laws.
(v) When providing care as a part of a
prepaid plan a licensee shall provide competent, necessary care in a timely and
professional manner. All care recommended and rendered must be clinically
justified and appropriately documented.
(vi) A prepaid care plan is not health
insurance and does not meet the Affordable Care Act "individual mandate"
requirements for health insurance coverage.
(vii) The regulations in this section do not
release a licensee from any contractual obligations that the licensee has with
an insurer or other entity. A licensee who has contracted with an insurance
carrier shall adhere to the terms of their provider contract in regard to the
collection of copayments, co-insurances, and applied deductibles. A licensee
may not bill a reimbursement entity or a patient for any amount exceeding what
is earned and distributed to the licensee.
(b) Failure to abide with the requirements of this section shall be considered "unprofessional conduct" within the meaning of Chapter 7 and shall constitute grounds for disciplinary action by the Board.
Disclaimer: These regulations may not be the most recent version. Wyoming may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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