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California Model Benefits Insurers, at Physicians’ and Patients’ Expense, Physicians Tell Congress - 02/11/2020

Texas Medical Association physician leaders, along with their colleagues from California and the rest of the country, are on Capitol Hill this week, lobbying Congress to toss out a California-inspired provision from a rapidly moving health insurance bill.


Arbitration Law Will be “Messy,” Bring Operational Concerns, Panelists Say - 01/31/2020

 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.


Texas' New Surprise Billing Law: Are You Ready? - 01/29/2020

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.


TDI Explains Arbitration Law Process - 01/28/2020

Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.  The Texas Department of Insurance has provided further details on how the law will be implemented, including how the arbitration process will work.


Insurance Commissioner to Health Plans: Be Proactive on New Surprise Billing Law - 01/28/2020

In a letter Tuesday addressed to “the health plans of Texas,” the Texas Department of Insurance (TDI) commissioner said TDI will monitor how health plans implement Senate Bill 1264, passed during last year’s session of the Texas Legislature and now in effect.


Climate Change, Surprise Billing/Insurance Delays to Top TMA Conference - 01/22/2020

How does climate change threaten the health and survival of humans? Beyond obvious threats like heatstroke, doctors and other scientists suspect climate change factored in the 2012 Dallas epidemic of West Nile encephalitis and the spread of other tropical diseases shared by mosquitos. One physician expert points to climate change as a contributing factor for allergies, asthma, worse COPD conditions, and heart attacks. Physicians will address this timely issue and more during the 2020 Texas Medical Association (TMA) Winter Conference in Austin this week.


State Adopts Emergency Rule on Surprise Billing Law - 12/20/2019

The Texas Department of Insurance has adopted an emergency rule outlining the narrow circumstances when it will be legal for physicians to balance bill patients under the state’s new law that protects patients from surprise medical bills. And the Texas Medical Board is telling physicians to accept how TDI interprets the law in its emergency rule.


Tell Congress to Oppose Surprise Bill Compromise - 12/13/2019

If you see patients, if you take private insurance, you need to know that Congress is about to let Big Insurance set your fee schedule even lower than it is now... if they let you into their ever-narrowing networks. The Texas Medical Association strongly urges you to call or  email your U.S. representative immediately. Tell him or her you want to protect patients from out-of-network surprise medical bills, but you don’t want to give the health plans more power than they already have.


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.


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.


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.


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.


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.


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.