Insurance

TMA Seeks to Protect Patients’ Access to Care in New “No Surprises Act” Rules Lawsuit - 12/01/2022

Amid concerns about threats to patients’ access to physicians’ care, the Texas Medical Association (TMA) has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the July 2021 interim final rules implementing the federal No Surprises Act (NSA). This is the third lawsuit TMA has filed against federal agencies related to rulemaking under the law.


Deal or No Deal: Negotiating Contracts - 11/28/2022

Maximize your leverage when negotiating a health plan contract.


Blues to Expand HMO Network in January; Check Your Status - 10/21/2022

Blue Cross and Blue Shield of Texas (BCBSTX) will expand its MyBlue Health HMO network to six Texas counties starting in January.


TMA Urges District Court AGAIN to Protect Patient Access in “No Surprises Act” Final Rules - 10/13/2022

The Texas Medical Association (TMA) today announced it has filed a new lawsuit in the U.S. District Court for the Eastern District of Texas, challenging certain portions of the Aug. 26, 2022 final rules implementing the federal No Surprises Act (NSA). This is the second time in less than a year TMA has filed a lawsuit against federal agencies related to rulemaking under the law.


TMA: No Government Price Controls for Out-of-Network Billing Disputes - 10/13/2022

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.


TMA President: Rulemaking on Surprise Billing Must Be Fair to Docs - 10/08/2022

Now that the Texas Legislature has passed a measure to counteract surprise billing involving many state-regulated plans, it’s time for rulemaking. The Texas Medical Association is working to make sure the Texas Department of Insurance’s eventual rules borne out of Senate Bill 1264 will give physicians a fair shake.


Panel Makes Big Change in Draft Federal Surprise Billing Law - 10/08/2022

Thanks to incessant lobbying from physicians, hospitals, organized medicine, and the Physicians Advocacy Institute, a key congressional committee today made significant revisions in a bill to reduce the strain of surprise billing on patients. “This certainly sounds like an improvement,” said Texas Medical Association President David Fleeger, MD, “but the devil will be in the details.”


Pass-Through Billing Generally Not Permitted - 09/14/2022

Pass-through billing occurs when an ordering physician requests a service and bills insurance for it but does not perform the service. Insurance companies generally forbid this practice.


United Overpayment Notices Go Paperless as of Sept. 23 - 09/07/2022

Beginning Sept. 23, UnitedHealthcare will no longer mail overpayment notification letters for most of its Medicare Advantage and commercial health plans, shifting them instead to its digital portals.


Sponsored Content: Get Group PPO Health Insurance – Without Employees - 08/23/2022

You know that if you’re an independent practice owner with employed staff, group PPO health insurance is an option for you. But what if for you, practicing as an independent physician means you are truly independent, with no employees?


Health Insurers Now Required to Post Comprehensive Price Data - 08/01/2022

Physicians, patients, and employers have long wondered whether they’re getting a fair shake from health insurers, whose prices have been clouded in secrecy – until now.


Cigna Delays Records Request Policy, Staving Off “Administrative Nightmare” - 06/29/2022

Cigna has delayed the implementation of a new billing policy after the Texas Medical Association and others in organized medicine pushed back, warning that it would have negative implications for physicians, practice staff, and patients.


Cigna to Request Records for Certain Office Visits, Unleashing Possible “Administrative Nightmare” - 05/26/2022

Cigna recently began alerting physicians to a new billing policy that could have far-reaching consequences for Texas physicians, practice staff, and patients.


Turn to TMA to Resolve Insurance Hassles - 05/19/2022

If you or your practice is dealing with prompt-pay or other health plan problems, the Texas Medical Association can help resolve those issues through TMA’s Reimbursement Review and Resolution Service. The Texas Department of Insurance last week released a bulletin reminding plans that a portion of prompt-pay penalties must be paid to the state.


Feds Finally Open Dispute Portal Under Surprise-Billing Law - 04/20/2022

Physicians needing to formally settle a dispute with insurers over certain out-of-network payments under the federal No Surprises Act finally can initiate that process online.


New Telehealth Code Sparingly Adopted - 04/20/2022

Despite the availability of a new Medicare code corresponding to telehealth provided to patients at home, Texas Medical Association payment staff say health plans are adopting it sparingly.


Surprise Billing Rules Garner More Legal Action - 04/05/2022

Pressure is mounting on federal authorities with several legal actions now aiming to stop what physicians and hospitals say is an unfair arbitration process outlined in rules implementing the No Surprises Act, legislation passed in 2020 to address surprise medical bills.


Court Hearing Approaches in TMA Surprise Billing Lawsuit - 04/05/2022

With a Feb. 4 court hearing on the horizon, the Texas Medical Association recently reiterated its strong opposition to a part of a federal rule that medicine says unfairly favors health insurers when directing arbiters to resolve payment disputes between insurers and physicians under the federal surprise billing law.


Power Data: Texas' Claims Database Will Help Clarify Care Costs - 03/31/2022

Texas is building an all-payer claims database, which will provide a clearer view of opaque health care costs.


Communication Amid Complexity: An Interview With TDI Commissioner Cassie Brown - 03/31/2022

With a number of new and fluctuating state and federal laws and regulations, Texas Department of Insurance (TDI) Commissioner Cassie Brown has her plate full when it comes to health plan regulation.


A Looming Deadline: What the Public Health Emergency's End Means for Coverage - 03/31/2022

The end of the public health emergency could mean big changes to Medicaid, telemedicine, and private insurance coverage.


AMA: High Concentration in Insurance Markets - 03/31/2022

Most U.S. commercial health insurance markets are “highly concentrated” among the top insurers in those markets, and evidence strongly suggests insurers are “causing competitive harm to consumers and providers of care.” Those were the findings of the American Medical Association’s 2021 update to its annual study, Competition in Health Insurance.


Navigating a Broken System: Helping Patients Use Health Resources - 03/31/2022

Whether patients do or don’t have health insurance, they need physicians’ help to make the most of their health care resources.


Medicaid to Fix Physician Enrollment Problems With TMA's Help - 03/31/2022

A rocky start for the state’s new Medicaid Provider Enrollment and Management System frustrated a number of practices around the state – and caused some worries that care they provided might go unpaid.


Out-of-Network and What It Means - 03/03/2022

A physician is out-of-network when a contract has not been established with a health plan. Get tips on what to do when providing services to out-of-network patients.