RHS Refund Policy & Applicable Laws
Right Health Systems (RHS) issues refunds in accordance with its internal refund policy and all applicable federal and state laws governing healthcare billing, insurance, and consumer protection.
1. Federal Laws & Regulations
a. HIPAA (Health Insurance Portability and Accountability Act)
- Refund processing must protect patient privacy
- Patient billing and payment data are treated as Protected Health Information (PHI)
- Refund communications are limited to authorized parties only
RHS ensures refund requests and processing comply with HIPAA privacy and security standards.
b. FTC & Consumer Protection Principles
- Patients must receive clear disclosure of refund terms
- Refund denials must be reasonable and policy-based
- Billing errors must be corrected in a timely manner
RHS maintains transparency in refund eligibility and timelines.
2. State Laws (Texas-Based Operations)
a. Texas Health & Safety Code
- Requires accurate billing and timely correction of errors
- Supports patient rights to dispute incorrect charges
b. Texas Deceptive Trade Practices Act (DTPA)
- Prohibits misleading billing or unfair financial practices
- Requires clear refund and cancellation disclosures
RHS refund decisions are guided by fairness, accuracy, and documented policy.
3. Insurance & Contractual Obligations
RHS refund practices also comply with:
- Provider agreements with commercial insurance carriers
- Medicaid Managed Care Organization (MCO) contracts
- Self-pay and sliding-scale program guidelines
Refunds are not issued until contractual obligations are satisfied.
4. How RHS Applies These Laws in Practice
RHS:
- Issues refunds only after insurance processing is complete
- Returns overpayments caused by billing or administrative errors
- Denies refunds for services properly rendered and billed
- Applies credits to accounts when legally or contractually required
- Maintains written documentation for all refund determinations
5. Patient Rights Under the Law
Patients have the right to:
- Request a review of their account balance
- Receive an explanation of refund decisions
- Obtain corrected billing statements
- File disputes in accordance with state and federal regulations
6. Policy Controls & Compliance
To remain compliant, RHS:
- Reviews refund activity during audits
- Trains staff on billing and refund regulations
- Updates refund policies as laws change
Right Health Systems, a 501(c), licensed health care system forged on the pillars of Advocacy, Collaboration, and Education. EIN: 39-4092536