The law aims to remove patients from billing
disputes between health plans & doctors, but it only applies to the 16% of
Texans with state-regulated health insurance.
Author: Edgar
Walters (The Texas Tribune) Published: January 3, 2020 Updated: January
3, 2020
A new Texas law that aims to protect patients
from receiving surprise medical bills takes effect this week. Consumer advocates have praised the
law as one of the most robust set of billing protections in the nation, though
it only applies to about one-third of Texans with private health insurance.
The intent of Senate
Bill 1264 is to remove patients from billing disputes between
state-regulated health insurance plans and health care providers.
Previously, when a health insurer declined to
pay the full price charged by an out-of-network doctor for a medical procedure,
the doctor could bill the patient for the remainder, or balance, of the cost.
Such “balance bills” often took patients by surprise. For example, a patient
who received surgery at a hospital within his or here health insurance network
might unknowingly receive care from an out-of-network anesthesiologist, who
could send the patient an expensive balance bill if the insurer declined to pay
the anesthesiologist’s full rate.
Now, insurers and health care providers must
leave the patient out of billing disputes and negotiate prices for
out-of-network care using an arbitration
process.
The law applies to Texans with state-regulated
health plans, which includes most state employees and public school teachers,
people who purchase insurance through the Affordable Care Act marketplace and
some people who receive health insurance through their private employers. A
person’s health insurance card will bear a “TDI” or
“DOI” imprint if the health plan is state-regulated.
About 16% of Texans have state-regulated health insurance,
according to the Texas Department of Insurance. Roughly one-third of Texans
with private insurance have state-regulated plans, according to the
left-leaning Center for Public Policy Priorities, a think tank that supported
the new state law.
The new law bans balance billing for emergency
care. In nonemergency situations, there is an exception that allows providers
to charge balance bills to patients who intentionally seek out-of-network
providers. In those cases, the state’s insurance agency offers a disclosure
form for providers to ask patients to sign.
Disclosure: The Center for Public Policy
Priorities has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan
news organization that is funded in part by donations from members, foundations
and corporate sponsors. Financial supporters play no role in the Tribune's
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