Early report on new balance billing protections

Kent Sullivan
Insurance Commissioner

Remember surprise medical bills? For some Texans, they’re becoming a thing of the past.

Senate Bill 1264 protects consumers from surprise medical bills if they have certain types of health plans and get emergency care outside their plan’s network or when they didn’t have a choice of doctors. The law applies to health plans with provider networks regulated by the Texas Department of Insurance (TDI) and to coverage through the state employee or teacher retirement systems – or about 20% of Texans.

The new protections apply to bills for services received since the start of 2020. Under the law, TDI was asked to set up an arbitration process for physicians and other providers to resolve payment disputes and a mediation process for facilities and labs.

Although the data is still limited, we compiled a preliminary report based on the first six months of data as an early indication of how the system is working:

As of June 30, 2020, TDI had received more than 9,000 requests for dispute resolution under the new process.
We’ve received 19 consumer complaints about balance billing in the first six months of 2020, down from 546 for the same period in 2019.
Provider complaints have decreased more than 70% this year. Before SB 1264, consumers could request mediation for certain surprise bills, but the only recourse available through TDI for providers seeking to resolve billing disputes was to file a complaint.
Through June, the majority of requests for arbitration were resolved during the 30-day informal negotiation period provided by the law. These disputes did not require an arbitrator to wade in.

As required by SB 1264, we’re collecting detailed information from health plans and medical licensing boards to examine the effects of the legislation. That report is due by December 1.

If you need help with a surprise bill, call us at 1-800-252-3439 or visit our website to learn about your options.

More to come...