Commercial Insurance

TMA submitted written testimony Tuesday to the House Committee on Insurance, providing details and recommendations on price gouging, surprise medical bills, health insurance premiums, and more caused by the COVID-19 pandemic.

The Texas Medical Association has been closely following how physicians and practices should bill the costs of administering COVID-19 vaccines once a vaccine is made more available throughout the state. 
Individual health plans, Medicare, and Medicaid will cover COVID-19 vaccine administration fees without cost-sharing, TMA has learned. Meanwhile, the federal government will pay for each COVID-19 vaccine serum – even if it is part of a claim – at least through the end of the national public health emergency, TMA understands. 

Many health insurers in Texas are waiving patient costs associated with COVID-19. Last week in a news release, Gov. Greg Abbott and the Texas Department of Insurance asked insurers and HMOs to cover testing consistent with Centers for Disease Control and Prevention guidance, and telemedicine visits.

As you’re no doubt aware, telemedicine has made it possible for many physicians to continue seeing patients while reducing the risk of spread during the COVID-19 pandemic.

Temporary changes to state and federal rules, particularly regarding payment for services, have helped push up the new demand for and use of telemedicine. 

In the wake of COVID-19, TMA is getting calls about which payers are covering telemedicine. TMA developed this quick reference guide to help you navigate telemedicine reimbursement. This table now reflects Medicare’s waiver of the geographic and place of service restrictions for Medicare (which means patients can now be at home).

Additionally, the Governor directed TDI to issue an emergency rule related to the payment of telemedicine to allow state-regulated plans (about 20% of the commercial market in Texas) to allow telephone and telemedicine visits to be paid at the same rate as in-office visits. If you are not sure which patients are regulated by TDI, check this guide.  Stay tuned for more detail.

Updated July 27, 2020

UnitedHealthCare (UHC) postponed a plan that would require Texas physicians to substantially increase their professional liability insurance coverage in order to participate in its networks.

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.

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 Reimbursement Review and Resolution Service (formerly known as the Hassle Factor Log program).  

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.