Commercial Insurance

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes.

Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. 

Every day, patients pay a hefty price for their health care, and many are quick to blame rising costs and climbing insurance premiums on the first person that comes to mind: usually the “well-paid physician.”

Don’t let your patients place blame on you unfairly.

Arguably one of the biggest issues Texas lawmakers tackled this session was surprise billing, as they vowed to protect patients from receiving medical bills for care not covered by insurance.

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Hassle Factor Log program.  

You’re probably already aware that open enrollment for commercial health insurance plans, including those on the Affordable Care Act (ACA) Exchanges, opened Nov. 1 and will run through Dec. 15. 
While some patients won’t make any changes to their coverage, others will make significant changes, including enrolling with a completely different health plan. 

As a result of recent changes in federal regulations, short-term health insurance plans aren’t so “short” anymore.

Traditionally, short-term plans were meant to act as stop-gap coverage for 30 to 60 days, and were usually purchased by workers between jobs. Now short-term plans can be sold for up to 364 days, and can be renewed for up to 36 months. 

Physicians have received more than 2 billion dollars in benefits from the settlement agreements reached with Aetna, CIGNA, Health Net, Humana, Anthem/WellPoint, and many Blue Cross and Blue Shield Plans as a result of class action lawsuits brought against these insurers by 19 state and county medical associations and physician representatives.