• Health Insurance

    • The Real Truth About "Surprise Bills"

      A pair of new TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services.
  • Current Health Insurance Articles

    • Wins
      TMA Wins Big for You in 2015 Legislative Session - In a 2015 legislative session marked by new state leadership, new money, and big shifts in how Texas' major health care agencies oversee care delivery, the House of Medicine remained as steady as ever in its mission to ensure physicians can give their patients the best care possible. That resolve paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.
    • Contracts
      Contracts rule the medical workplace. Health plan contracts, employment contracts, and vendor contracts can work for you -- or against you. Check out this page for contract basics, contract clauses to watch out for, and calculating payment rates.
    • The Uninsured in Texas
      Texas is the uninsured capital of the United States. More than 5.04 million Texans - including 784,000 children - lack health insurance. Texas' uninsurance rates, 1.5 to 2 times the national average, create significant problems in the financing and delivery of health care to all Texans. Those who lack insurance coverage typically enjoy far-worse health status than their insured counterparts. Who are those Texans? This comprehensive page includes extensive demographic data, including county-by-county breakdowns of the uninsured in Texas.
    • Commercial Insurance
      Tips and strategies on how to deal with commercial health insurance companies. What TMA is doing to help you and your patients deal with them. Networks and contracts. Billing. Balance billing. Physician ranking.
    • Meaningful Prompt Pay Remedies Still Needed
      Testimony by Patricia Kolodzey: Associate Director, TMA Legislative Affairs DepartmentHouse Committee on Insurance, March 30, 2016 On Interim Charge # 3: Evaluate the statutory penalty calculations under Texas's prompt payment laws regarding health care claims. Include an analysis of whether the proper benchmarks are used to establish penalties commensurate with an improper payment and the effect of the abolition of the Texas Health Insurance Pool on the use of funds collected under the statute.
  • Key Issues

    • TMA: Establish Fair and Transparent Insurance Markets
      While Texas physicians want better access to coverage for their patients, they are frustrated by the confusion and administrative burdens imposed by the federal government’s implementation of insurance exchanges. Significant problems also remain — and potential new ones are developing — with traditional health insurance companies and Texas’ workers’ compensation program. TMA has a plan of attack.
    • Under New Management An Interview With TDI's Newest Boss
      The end of the 2013 session of the legislature marked the beginning of new leadership at the Texas Department of Insurance (TDI) as Gov. Rick Perry appointed Julia Rathgeber to the helm of the agency in late May. The Senate unanimously confirmed that appointment in June.
    • Keep Insurers Honest: TMA: Appeal Your Health Plan Rankings
      In spring 2011, Aetna notified El Paso plastic surgeon Deborah Seelig, MD, it was dropping her from its Aexcel physician network for not meeting certain criteria under the network's physician-ranking program.
    • AMA: Bad Claims Payment Increasing
      It's not your imagination. Most health insurers are getting worse at correctly paying physicians' claims, the American Medical Association says in its fourth annual National Health Insurer Report Card.
  • Texas Advocacy and Communications

    • Ban Virtual Credit Cards
    • 2015 Legislative Testimonies and Letters
      TMA physician leaders are working on behalf of their profession and their patients to improve Texas health care system. During the this legislative session, TMA councils and committees are locking down and promoting health care policies to ensure Texas’ patients have access to affordable and high quality health care. Read TMA’s testimonies, comments, and letters to state lawmakers.
    • ACA Exchange Plans: Q&A for Texas Physicians - Updated December 2014
      Confused by all you've heard about the Affordable Care Act marketplace insurance plans? Do you know whether you're in — or out — of the narrow networks? How will you tell if a patient is on an exchange plan? What happens to you if patients don't make their premium payments? What, if anything, can you do about all of this? TMA answers these and other tough marketplace exchange questions.  MembersOnlyRed
    • Physicians Prepare for Round Two of the ACA Marketplace
      Round two of the Affordable Care Act (ACA) health insurance marketplace launched with far less fanfare than last year's botched rollout. But even as physician practices do their part to adjust and help care for these newly insured, some of the same uncertainties linger. And with potentially new twists ahead, TMA officials once again remind physicians to be mindful in their business practices surrounding exchange plans.
    • TMA Healthy Vision 2020: Establish Fair and Transparent Insurance Markets
      Read TMA’s legislative strategy and recommendation for 2015 and beyond.
    • TMA Develops Tooklit to Help You Challenge Unfair Rankings
      Physician ranking (also known as physician tiering) has traditionally been a profiling methodology used by private insurance companies to steer patients toward lower-cost physicians.
    • 83rd (2013) Legislative Victories
      It took more than six years, but TMA and our state legislators never gave up. Now a new law regulating silent PPOs penalizes unethical third parties who steal and resell physicians’ discounted rates, for commercial and Medicaid contracts. Lawmakers also passed a prompt-pay law for Medicaid HMOs; no more low-pay, slow-pay, no-pay.