Out of Network

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.


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.   


Plan Directories Should Cross-Reference Physician Network Status - 03/25/2019

As a physician, I rely on online health plan network directories to see not only my own network status but also that of physicians and facilities I refer patients to for additional care and treatment. While I can find what physicians are in network and what facilities are in network, there is no easy or uniform way to cross-reference the facilities at which the facility-based physicians provide services.


Insurers’ Delays Burden Patients, Physicians; Could Cost Patients More - 11/16/2016

A growing number of physicians say health insurers are slow to enroll them as plan providers in the health plan’s insurance network, which spells fewer physician choices for patients and financial strife for the doctors. The process of “credentialing” — when plans contract with a doctor, finalize enrolling him or her in their system, and acquire hospital and facility privileges for the doctor — is taking twice as long as normal. Physicians say three of the state’s biggest health plans, UnitedHealthcare (UHC), Aetna, and Blue Cross and Blue Shield of Texas (BCBSTX), are delaying enrolling doctors in networks to reduce plan costs and increase the plans’ revenue.