§ 146.001.Definitions

Two definitions, and the first is drawn to catch every way medical costs get paid.

"Health benefit plan" means a plan or arrangement under which medical or surgical expenses are paid for or reimbursed or health care services are arranged for or provided. It includes five things:

an individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service contract; an evidence of coverage or group subscriber contract issued by an HMO or approved nonprofit health corporation; a benefit plan provided by a multiple employer welfare arrangement or analogous arrangement; a workers’ compensation insurance policy; and a motor vehicle insurance policy, to the extent it provides personal injury protection or medical payments coverage.

The last two are the ones that surprise. Workers’ compensation and motor vehicle med-pay are not health insurance in ordinary usage, but both pay medical bills — and both are common in exactly the cases where late billing causes trouble.

"Health care service provider" means a person who, under a license or other grant of authority issued by this state, provides health care services the costs of which may be paid for or reimbursed under a health benefit plan.

The licensure requirement is the limit. An unlicensed provider is outside the chapter — and so, on the face of the definition, is one licensed by another state.

"Or other grant of authority" widens it beyond individual licences to facilities and entities authorised by the state rather than licensed in the ordinary sense.