Related Stories

Payers Extend Prior Authorization Windows During COVID-19 - 05/19/2020

Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency. Here is an overview of some payers’ COVID-19 prior authorization policies.


TDI Fines Blue Cross $10 Million for Delays, Errors - 03/11/2020

Blue Cross and Blue Shield of Texas will pay a $10 million fine for providing consumers incorrect information, delays in out-of-network claims processing, and errors in marketing materials, the Texas Department of Insurance has announced.


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.


TMA Keeps Pressing Congress on Surprise Billing - 03/09/2020

As lawmakers continue their work on a federal solution to surprise medical bills, the Texas Medical Association is on guard to make sure patients will be protected – and physicians get a fair shot to get paid properly. TMA joined 18 other state medical and specialty societies on a letter last week to the chairs and ranking members of three U.S. House committees.  


Making Billing More Balanced: Congress Considers Surprise Billing Legislation - 03/05/2020

The widespread call to severely curb or end “surprise” medical bills prompted competing federal legislation during the summer and fall of 2019. The negotiations, maneuvering, and bill markups have continued into this year.   


Which Presidential Candidate Stands for What Again? - 02/24/2020

A group of dedicated Harris County physicians has a cure for “too many candidates confusion disorder.” They compiled a simple table of the candidates’ positions on seven key health care policy issues based on the candidates’ official websites and The Washington Post’s “We’re Asking 2020 Democrats Where They Stand on Key Issues.”


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.


UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent - 02/05/2020

If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a nonemergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.


A Plan for the Uninsured in Texas - 02/05/2020

I call for our TMA to bring all of these groups together to directly address the issue of the uninsured in Texas, to plan a strategy, and to put it in motion.


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.


Send TMA Your Prior Auth Nightmare Stories - 01/31/2020

Arbitrary. Confusing. Frustrating. Never-ending. Maddening. Those are some of the terms we can actually print that describe physicians’ perceptions of insurance companies’ prior authorization requirements and approval processes. Your personal stories of patient harm due to prior authorization request delays or denials can give the Texas Medical Association the ammunition it needs to fight this problem. Please submit your stories via email to the TMA Payment Advocacy Department.


Insurance Companies Have Denied My Doctor’s Orders, 25% of Texas Voters Say - 01/29/2020

One in four Texas voters say their health insurance company has refused to cover what their physician ordered for them or their families, a new statewide survey has found.


Register to Vote by Monday - 01/29/2020

Elections, particularly the spring party primaries, determine the practice environment for Texas physicians and our patients. And election season is upon us. To help elect medicine-friendly candidates in the March primaries, you must be registered to vote by Monday, Feb. 3.


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.


Medicare Sequestration Cuts, GPCI Floor Continue - 01/07/2020

As we begin 2020, it’s a good time to remember that several Medicare policies that affect physician payment remain in effect. Medicare sequestration, the federal government’s 2% across-the-board payment cut, will continue until further notice. In addition, Medicare’s 1.0 floor for the Geographic Practice Cost Indices (GPCI) has been extended temporarily, once again, to May 23.


Request UnitedHealthcare Peer-to-Peer Review Online - 01/02/2020

Seeking a peer-to-peer conversation after a preauthorization request was declined? Now you can request one through an online form available on UnitedHealthcare’s Prior Authorization and Notification webpage.


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.


New House Committee Takes on Health Care Costs - 12/16/2019

Two physician legislators will serve on a newly created House Select Committee on Statewide Health Care Costs during the Texas Legislature’s interim year in 2020. The committee will examine the “primary drivers of increased health care costs in Texas.  


Review Cigna Patient Feedback Before It Goes Public - 12/13/2019

Now is the time to preview your patients’ reviews that will appear in myCigna.com provider directories starting in early 2020 – or you can opt out of having your patient reviews published in Cigna’s directories.


Social Media A Vital Tool for Influencing Policy, Panel Says - 12/13/2019

Social media has become indispensable for politicians to reach voters, but it's also a crucial way for voters – like physicians – to influence decision-makers and public opinion, a panel of state representatives and social media consultants said at the Texas Medical Association's Advocacy Retreat on Saturday.


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.