Balance Billing

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

Swinging For Fairness: Law Creates New Ballgame for Surprise Billing - 08/02/2019

When Senate Bill 1264 was first introduced in February, insurers had the bases loaded, threatening to score a lopsided surprise-billing victory on one swing. With some deft pitching in the Texas Legislature, medicine worked its way out of the jam. The “baseball-style arbitration” measure by Sen. Kelly Hancock (R-North Richland Hills) isn’t perfect, and like a hitter who’s getting busted inside, physicians will have adjustments to make. But the improved SB 1264 passed with a framework that’s fairer to everyone involved.   

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.

Specialties List Scope, Balance Billing Among Top Targets for 2019 - 12/04/2018

Representatives of more than 20 specialty societies ran through each organization’s top priorities for the 2019 Texas Legislature during the Texas Medical Association’s annual Advocacy Retreat on Saturday morning at the Renaissance Austin.

Free Market Insurance Solutions Must Protect Texans - 05/08/2018

Overall, policies sold over state lines to Texans need to be regulated by the state of Texas to safeguard consumers and afford them the same protections and opportunities as they receive with Texas-based policies, such as our current mediation process for out-of-network balanced bills.

Information Accuracy and Oversight Will Minimize Surprise Billing - 05/08/2018

I would like to start by thanking this committee for your work on Senate Bill 507 by Senator Hancock, which expanded the mediation process for certain out-of-network claims. Mediation is working well in Texas and has offered patient protection in light of health plans narrowing their networks. The expanded mediation model under SB 507 is currently in the rulemaking process at the Texas Department of Insurance (TDI).

Protect Physicians from Billing-Situation Burden - 04/27/2018

SB 2127 generally would prohibit a credit reporting agency from including on a credit report a collection account for certain health care services if (1) the consumer was covered by a health benefit plan when he or she received services, and (2) the collection was for an outstanding balance (after copays, deductibles, and coinsurance).  While physicians are not in the business of, or interested in, reporting a patient to a credit agency, this legislation could result in consequences adverse to the health care market and patients as it relates to out-of-network care.

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.

TMA Lays Out Balance Billing Plan to Senate Panel - 04/27/2018

Just days after the House of Delegates adopted TMA's plan to preserve physicians' rights to bill for services and protect patients from surprise bills, TMA Council on Legislation Chair Ray Callas, MD, presented it to the Senate Committee on Business and Commerce.

Warning: No Balance Billing for Dual Eligibles - 04/27/2018

The Centers for Medicare & Medicaid Services reissued guidance recently to remind physicians of the prohibition on balance billing for patients who are covered by both Medicare and Medicaid.