Health insurance companies' use of narrow networks and unexpected limits on how they pay for services out of network are leaving Texans with medical bills they didn't expect. A new TMA white paper explores, "How Health Insurance Company Practices Leave You Without the Coverage You Thought You Bought." Written for the layperson, journalist, and policymaker, this easy-to-follow guide connects the dots between insurance company business practices and patients' surprise bills.
Are your patients frustrated to have health insurance coverage but still receive unexpected medical bills. Share this video to help them earn about Stanley and the surprise medical bills he received… and learn why he received them.
States around the country have been passing laws limiting physicians' rights to bill for the services they provide. TMA is determined not to let that happen in Texas. Meet with your state senators and representatives now to educate them about the real causes of surprise billing and to secure their support for TMA's even-handed solutions.:
TMA research shows how narrow networks and other health plan practices — not physician billing — are bearing down on patients in the form of unexpected, out-of-network balance bills. Texas Medicine explores the findings of TMA's extensive research and the association's plans to fix a growing problem for Texas patients.
Warning: No Balance Billing for Dual Eligibles (Action – July 15, 2016)
TMA's Plan Preserves Physicians' Billing Rights (Action – March 15, 2016)
Improving Network Adequacy and Out-of-Network Billing Policy - Report of the TMA Board of Trustees (TMA House of Delegates 2016 Annual Meeting)
TMA Calls Out Insurance Companies Over Balance Billing (Action – Nov. 2, 2015)
Balance-Billing Ban Back in 2015 Legislature: TMA Strikes at the Heart of the Issue: Inadequate Health Plan Networks and Benefit Designs (Texas Medicine – May 2015)
Lifting the Veil: Price Transparency Efforts Target Physicians (Texas Medicine – July 2014)
Check out these TMA research papers on charges, insurance company contracting, and insurance company networks.Physician Charges Do Have Meaning
How to Appeal Being Dropped From a Network
Physician Prices, Fee Schedules, and Managed Care Contract Offer and Acceptance
TMA has created a draft TDI complaint letter you can customize for your patients. We have it available in both English and Spanish. Complaints about a health plan’s network may include problems locating a specialist who is accepting new patients, finding a doctor within reasonable driving distance from the patient’s home, or inaccurate information in the health plan’s provider directory.
Some surprises are fun; surprise bills aren't.
TMA has developed a one-page patient handout describing the most common reasons for "surprise" medical bills. There's also a longer document for those who want more details.
Got questions about Surprise Bills? Call the Knowledge Center.