Balance Billing

Court Hearing Approaches in TMA Surprise Billing Lawsuit - 07/17/2023

With a Feb. 4 court hearing on the horizon, the Texas Medical Association recently reiterated its strong opposition to a part of a federal rule that medicine says unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the federal surprise billing law.


New Laws Reshape Texas Health Care Landscape - 06/29/2023

New laws are about to transform health care in Texas, addressing long-term issues like surprise medical billing, raising the tobacco-use age, and improving Medicaid. The 2020-21 state budget also includes vital funding increases for women’s health programs, graduate medical education (GME), and community mental health services


TMA: No Government Price Controls for Out-of-Network Billing Disputes - 10/13/2022

The government shouldn’t set the fees physicians are paid for out-of-network care. That’s the message the Texas Medical Association is sending to key members of the U.S. Senate as lawmakers consider a troubling federal bill.


CMS Continues Webinar Series on No Surprises Act - 07/07/2022

Two upcoming webinars from the Centers for Medicare & Medicaid Services (CMS) – including one scheduled for next week – will educate physicians on the federal No Surprises Act (NSA) as part of a collaboration between CMS and the American Medical Association.


Federal Surprise Billing Law in Effect: Get Educated - 04/05/2022

Despite ongoing litigation over certain aspects of the federal surprise billing law, the patient protection components of the No Surprises Act still took effect at the beginning of the year. With them come a number of changes that could significantly impact physician practices now that balance billing is largely prohibited.


AMA Toolkit Dissects Federal Surprise Billing Law - 04/05/2022

Much of the federal government’s solution to resolve certain out-of-network billing disputes without balance billing or otherwise involving patients – known as the No Surprises Act – took effect at the start of 2022.


TMA Sues Feds Over Arbitration Rule for Surprise Billing Law - 03/02/2022

The Texas Medical Association has sued federal authorities over rulemaking for the federal surprise billing law, saying it failed to follow clear direction from Congress about how to implement the dispute resolution process meant to determine fair payments for out-of-network care.


TMA, Other Physician Groups Urge Reconsideration of Surprise Billing Rule - 11/24/2021

While the Texas Medical Association awaits action on its lawsuit over part of recent rulemaking for the federal surprise billing law, TMA recently teamed with the American Medical Association and others to engage the Biden administration outside court.


Payment Process Problematic Under Federal Surprise Billing Rules - 09/22/2021

The Texas Medical Association has weighed in on federal rulemaking to help curb surprise medical bills, telling federal authorities medicine supports many patient protections in the rules – but is deeply concerned with a key piece of the criteria to determine fair payments for out-of-network care.


Arbitration Requests Up, Consumer Complaints Down Under State Surprise Billing Law - 07/29/2021

Texas’ law to prevent patients from getting unanticipated bills for out-of-network care is resulting in more requests for arbitration between practitioners and insurers this year, while consumer complaints are on the decline since the law’s implementation, according to a Texas Department of Insurance report on the impact of the law six months into 2021.


Feds Release New Surprise Billing Rules - 07/16/2021

After passage of federal consumer protections against surprise and balance billing, the new law punted a lot of important details about enforcement to the federal rulemaking process.


Federal Lawmakers Agree to Surprise Billing Restrictions, Physician Payment Protections - 12/23/2020

Federal lawmakers put new restrictions on surprise medical billing, reduced requirements that would’ve cut physician Medicare payments, and secured COVID-19-related relief for physicians as part of a massive omnibus legislation package approved this week.


AMA Opposes New Federal Surprise Billing Measure, Urges More Discussion - 12/17/2020

The American Medical Association is opposing the latest “No Surprises Act” and urging more vetting of the bill, which was agreed upon this week by key House and Senate committee leaders.TMA agrees with AMA’s assessment of the bill.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 12/02/2020

 The state’s new law allowing arbitration of payment disputes on certain out-of-network care carries concerns for physicians and uncertainty about what it will look like from an enforcement standpoint, a panel told the Texas Medical Association Winter Conference on Saturday morning.


TMA Weighs In On COVID-19 Surprise Billing, Insurance Premiums, and More - 09/09/2020

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 Updated Skinny on Texas’ Surprise Billing Law - 07/08/2020

The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.


Are You Ready For Arbitration On Out-Of-Network Billing Disputes? - 07/07/2020

Learn more about Texas' new balance billing law in a free, live webinar on the Texas arbitration process on Thursday, July 16, at 6 pm (CT).


Physicians Applaud State for Fining Health Plan - 03/09/2020

Statement by Texas Medical Association (TMA) President David C. Fleeger, MD, about the Texas Department of Insurance (TDI) sanction of Blue Cross Blue Shield of Texas (BCBSTX) for delaying payment of certain out-of-network emergency care claims. TDI also found the plans distributed incorrect information about how to resolve balance bills to many HMO members who received out-of-network emergency care.


Miss the TMA Virtual Meeting? Watch It Now - 11/20/2019

Were you unable to tune in to the Texas Medical Association’s virtual meeting last week? If you missed it, you can check out the meeting anytime on TMA’s virtual meeting webpage.


Require Timely Updates to Network Directories - 04/12/2019

HB 1880 will help prevent out-of-network bills through proper consumer information but will also help in ensuring insurance companies have adequate networks.  While the bill as substituted does keep the 30 day update for directories intact, it does require that upon notice of contract termination by a health plan that an update must be made to reflect this change, in the directory within two days of the effective date of the change.  Additionally, in an era of more surprise bills due to the narrow networks of health plans, this information being accurate leads to be another tool in the toolbox of consumer protection.