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Far-Reaching Implications: The Ripple Effects of Texas' Uninsured Rate - 12/04/2019

Data compiled by the Texas Medical Association and other organizations, as well as physicians’ own anecdotal experiences, show how 5 million uninsured patients in Texas become 5 million dominoes. As they fall, so do countless others representing the health of Texas: The economy and well-being of entire communities. The classmates and friends of uninsured children. And yes, the physicians who deal with the burdens of treating uninsured patients in emergency rooms and providing uncompensated care.


Big Noises Big Issues: Health Care Takes Center Stage One Year Out From 2020 Election - 11/11/2019

One year from now, Texas voters will hit the polls. They’ll be voting for president, for Congress, and for seats in the Texas Legislature. At the state and national levels, health coverage, Medicaid access, and prescription drug costs have gotten plenty of attention already, and they’ll get plenty more between now and the closing of the polls on Nov. 3, 2020. Here’s a look at some of the major health care debates taking center stage during the 2020 election cycle, what voters are and will be hearing about, and what Texas Medical Association policy says on those particular issues.


Humana Changes for 2019: Preauthorization, Notification, and Formularies - 02/27/2019

Humana has made changes for 2019 to its preauthorization and notification lists.


Section 3: Hold Health Insurers Accountable - 01/30/2019

Beaumont anesthesiologist Ray Callas, MD, is tired of beating his head against the wall trying to get “in-network” with health insurance companies. And he’s tired of the surprise bills his patients receive when he can’t get in.  


Humana Revises Peer-to-Peer Review - 10/18/2018

Humana has tweaked its peer-to-peer review process for prior authorization requests, giving physicians contracted with its Medicare Advantage plans another opportunity for review before filing a claim.


TDI Fines Humana Over Inadequate Network - 10/12/2018

The Texas Department of Insurance has fined Humana $700,000 and ordered the insurer to take corrective steps for not having enough in-network anesthesiologists in Harris, Bexar, and Travis counties this year.


New Precerts, Edits From Aetna - 10/05/2018

Aetna will require precertification for endoscopic nasal balloon dilation, effective Nov. 1. This is one of several changes Aetna has announced to its National Precertification List.


Humana Peer-to-Peer Review Changing for Medicare Advantage Plans - 10/05/2018

Effective Aug. 1, Humana Medicare Advantage health plans will no longer offer peer to peer reviews after a medical necessity denial. Instead, the company will offer to schedule a peer-to-peer review before Humana issues the denial


Humana Physician Portal to Retire in October - 08/27/2018

Humana will shutter its secure provider portal on Oct. 3. To continue or begin working with Humana online, prepare now by registering for the Availity Provider Portal if your practice doesn’t already have an account.


Payer Roundup, January 2017 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about new preauthorization and payment policies, an evaluation and management code review — and a letter you may get from Novitas Solutions.


TMA Supports Bill to Improve Balance-Bill Mediation - 04/27/2018

Balance or “Surprise bills” may occur when a person insured under a preferred provider organization (PPO) unexpectedly receives services out of network. The mediation process for out-of-network billing is working well in the state of Texas and has been a tremendous patient protection with the narrowing of insurance networks. We have seen growth in the utilization of the mediation process grow from 14 requests in 2010, to 1,677 requests in 2016. Therefore, TMA is supportive of its expansion to all out-of-network health care providers at an in-network facility along with emergency care.  Additionally, we are pleased to see that the legislation maintains the $500 threshold as well as personal responsibility of the patient.


TMA Offers Remedies to Ease Surprise Billing - 04/27/2018

Texas patients sometimes feel the pain from unexpected out-of-pocket costs not covered by their health insurance, known as “surprise billing” or “balance billing.” The Texas Medical Association (TMA) is taking aim at the problem, which occurs when a health insurance company pays less than what a doctor charges, leaving the patient to pay the balance of the bill.


Transparency in Out-of-Network Payments Needed - 04/27/2018

Since the health plan’s contract or agreement is with the enrollee, we hope health plans don’t use the same argument, saying, “It’s proprietary” to circumvent the spirit of this legislation when their own enrollees make the same inquiry about the out-of-network payment methodology.


Private Payer Round-Up, March 2013 - 04/27/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Balance-Billing Ban Back in 2015 Legislature - 04/27/2018

Renewed attention in the 2015 Texas Legislative over balance billing stems in part from interim charges that tasked the Senate State Affairs and House Insurance committees to look at whether existing laws dating back to 2007 are working to inform patients ahead of time when out-of-network physicians might balance-bill them for services their health plans don't fully cover. The issue is in the national spotlight, too, with the proliferation of high-deductible and narrow-network plans sold in the Accountable Care Act insurance marketplace. New federal rules take aim at ACA plans' inadequate networks and inaccurate physician and hospital directories. The Texas Medical Association is pushing for similar health plan accountability measures at the state level, with a careful eye on legislation that could restrict out-of-network physicians' ability to balance-bill for services they legitimately provide.


Capitol Success - 04/26/2018

This legislative session, medicine resolved to ensure physicians can give their patients the best care possible. The hard work paid off in significant victories that largely build on the Texas Medical Association's 2013 legislative successes.


Private Payer Update, June 2012 - 04/20/2018

  In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists (June 2012).


Private Payer Round-Up, January 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, September 2013 - 04/19/2018

Formulary, preauthorization, and precertification changes and more … TMA’s reimbursement specialists have rounded up these other coding, payment, and policy changes and tips from commercial payers.


Private Payer Round-Up, October 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Roundup — April 2015 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists. Find out about an automated phone system change, and more.


Private Payer Round-Up, December 2013 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


Private Payer Round-Up, January 2014 - 04/19/2018

In case you missed these — here is a roundup of useful items from health care payment plans’ newsletters and updates, compiled by TMA’s reimbursement specialists.


AMA Analyzes Potential Aetna-Humana, Anthem-Cigna Mergers - 04/17/2018

The combined impact of proposed mergers among four of the nation's largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within Texas and 16 other states, according to new special analyses of commercial health insurance markets issued by the American Medical Association.


Bill Would Address Inaccurate Insurance Directories - 04/17/2018

With modern technology, there should be no issue in business daily updates to a health plan’s online provider directory.