Balance Billing

Congress Needs to Get This Right - 12/12/2019

The Texas Medical Association, with our nearly 53,000 physician and medical student members, was very pleased to see the Ways and Means Committee weigh in on the debate over surprise medical billing legislation. While the details are yet to come, the general outline of that proposal looks quite promising.


Texas' New Surprise Billing Law: Are You Ready? - 12/11/2019

Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law. That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law.


TMB Pulls Proposed Rule on Surprise Bills - 12/09/2019

The Texas Medical Board has withdrawn its proposed rules to implement pieces of the state’s new law introducing baseball-style arbitration on many out-of-network medical bills. At its meeting Friday, the board pulled down its rule proposal, saying in a statement that it “would not cover all providers under the statute.”


TMA Stands Firmly Against Surprise Medical Billing “Compromise” - 12/09/2019

“There is a right way and a wrong way to protect patients from surprise medical bills, and the so-called compromise federal legislation announced this weekend in Washington, D.C., is definitely the wrong way,” Texas Medical Association President David C. Fleeger, MD, said Monday.


TMA Makes Strong Push for Fair Surprise Billing Legislation - 12/04/2019

The Texas Medical Association is urging Texas lawmakers in Washington, D.C., to show their support for federal legislation on surprise medical bills that includes commercially reasonable upfront payments and independent arbitration.


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.


Virtual Meeting to Cover Surprise Billing Laws, TMA Member Benefits - 10/28/2019

But if you want to learn even more about Texas' new suprise billing law, or if you want to find out what’s new with the Lone Star Caucus – which represents your county in the Texas Medical Association’s House of Delegates – tune in to a 30-minute virtual meeting scheduled for noon on Tuesday, Nov. 12.


Medicine to Congress: Don’t Give Health Plans More Leverage - 10/24/2019

The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.


Have Your Say on Texas’ New Surprise Billing Law - 10/16/2019

The Texas Department of Insurance (TDI) is holding a public hearing next week on rulemaking for the state’s new “baseball-style arbitration” law to address surprise medical bills. If you wish to speak at the meeting, TDI requests you submit written comments or a summary of your testimony by noon Friday, Oct. 18 “to facilitate a meaningful discussion.”


New Laws Reshape Texas Health Care Landscape - 08/05/2019

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 - 06/25/2019

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.


Doctors to Lobby Lawmakers on Session’s Last “First Tuesdays” Event - 05/01/2019

Hundreds of Texas Medical Association (TMA) physicians, TMA Alliance members, and medical students will return to Austin for TMA’s First Tuesdays at the Capitol advocacy day next Tuesday, May 7.


Fix Surprise Billing and You’ll Fix the Need to Report Collections - 04/23/2019

Practicing medicine is our primary focus as we maintain our patient-physician relationships. Physicians do not want to report patients to credit agencies for unpaid accounts. Doing so harms our relationships with our patients. If we are successful in taking patients out of surprise billing scenarios, then credit reporting will no longer be an issue.


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.


Require Network Directory Accuracy - 04/09/2019

The basic product of a health insurance company is a comprehensive facility and physician network for the covered members. Balance billing events most commonly occur when a patient is receiving care at an in-network facility by an out-of network physician. The problem for both patients and physicians is not being able to easily match up the in-network facilities with in-network specialists. While I can find for a given city what physicians are in network, and what facilities are in network, there is no easy or uniform way to cross-reference the in-network facilities with in-network, facility-based physicians who provide services there.


Legislative Hotline: Bill to Raise Tobacco-Purchase Age Moving Forward - 04/05/2019

Lawmakers unveiled new balance-billing legislation this week, while several physicians testified on key issues such as limiting scope-of-practice expansions, medical liability, and pharmacy benefit managers. All of this and more in this week’s TMA Legislative News Hotline video.


Protecting Patients From Balance Bills - 04/02/2019

The committee substitute will hold harmless patients for expenses beyond their copay, coinsurance. and deductible for all emergency care and situations where a patient may receive a surprise bill for physician services, facility fees or diagnostic testing or imaging, and for special medical services ordered by an in-network physician.


Physicians to Return to Pack Capitol for “First Tuesdays” - 03/28/2019

Hundreds of Texas Medical Association (TMA) lab coat-clad Texas physicians and medical students, and TMA Alliance members will fill the Capitol for First Tuesdays at the Capitol advocacy day on April 2.


Take Patients Out of the Middle of Balance Billing – The Right Way - 03/25/2019

We are very much supportive of the need to protect the patient from a surprise out-of-network bill; however, our opposition to HB 3933 is driven by the modification of the mediation process and Texas law in a way that allows insurers to have more control over the market and places more of a financial burden on physicians and their practices.


Protect Patients From Inadequate, Narrow Networks - 03/21/2019

In an out-of-network surprise billing situation, the patient and the insurer have a contractual agreement. The physician and insurer do not. As a result, when we remove the patient from the claims settlement process, the insurer has little market accountability unless additional statutory protections are created.


Say No To Bill That Would Take Physicians Out Of Balance Billing - 03/20/2019

The Texas Medical Association is fighting a bill working its way through the Capitol that would allow insurance plans to unilaterally determine payment for out-of-network billing.


Evening Out the Scale: TMA Gears Up for Another Legislative Battle Over Surprise Bills - 03/20/2019

TMA gears up for another legislative battle over surprise bills.


TMA Leery of Proposed Balance Billing Law - 03/20/2019

The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide. On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine


More Physicians to Flood Capitol on March “First Tuesdays” Advocacy Day - 03/09/2019

Building on the great turnout and success of the Texas Medical Association’s (TMA’s) initial First Tuesdays at the Capitol advocacy day in February, TMA expects about twice the attendance for the March “white-coat invasion.” As many as 400 lab coat-clad Texas physicians and medical students, and TMA Alliance members will fill the Capitol to urge legislators to support good patient care on March 5. They will dedicate the TMA building to TMA Executive Vice President and CEO Louis J. Goodman, PhD, who is retiring, and some will attend a Tobacco-21 news conference.


Physicians to Fill Capitol on Feb. 5’s “First Tuesdays” - 02/01/2019

Continuing a 16-year tradition, hundreds of lab coat-clad Texas physicians and medical students, and TMA Alliance members will fill the Capitol to urge legislators to support good patient care during the Texas Medical Association’s (TMA’s) initial First Tuesdays at the Capitol advocacy day of the 86th Texas Legislature.