The Texas Medical Association’s Healthy Vision 2025 – released this week – seeks to draw a roadmap for how legislators can hold insurance companies accountable for the products they sell to patients.
Require Network Directory Accuracy(Testimony on Senate Bill 1742 by Rick Synder, MD, April 9, 2019)
Require Timely Updates to Network Directories(Testimony on House Bill 1880 by John Scott, DO, April 9, 2019)
Protecting Patients From Balance Bills(Testimony on House Bill 2967 and House Bill 3933 by Ray Callas, MD, April 2, 2019)
Enforce Network Adequacy(Testimony on of House Bill 3911 by Ray Callas, MD, April 2, 2019)
Plans Should Inform Patients of Network Status When Requiring PA(Testimony on House Bill 2520 by Debra Patt, MD, March 26, 2019)
Plan Directories Should Cross-Reference Physician Network Status(Testimony on House Bill 2630 by Rick Snyder, MD, March 26, 2019)
Prevent Non-Medical Switching by Plans(Written Testimony on House Bill 2099, March 26, 2019)
Protect Patients From Inadequate, Narrow Networks(TMA Testimony on SB 1264 by Jason Terk, MD, March 21, 2019)
Information Accuracy and Oversight Will Minimize Surprise Billing(Testimony on Interim Charge by Ray Callas, MD, Jan. 23, 2018)
“Remember the old saying: If we’re not at the table, we’re on the menu.”
That was the warning C.M. Schade, MD, past president of the Texas Pain Society, delivered as he finished listing the society’s priorities for the 2019 Texas Legislature during the Texas Medical Association’s annual Advocacy Retreat on Saturday morning at the Renaissance Austin.
The House of Medicine does what it can to address the factors that increase the odds of patients getting blindsided by unexpected, costly medical bills, and yet, the undead issue rises again and again.
A year after the house of medicine scored big wins on some of the state’s biggest insurance issues, the Texas Legislature is trying to dive further into what is and what isn’t working.
Following a big legislative win last year to protect physicians’ rights on balance billing, TMA weighed in Tuesday on how lawmakers can further reduce surprise medical bills.
Balance billing was one of TMA's biggest legislative wins this year. Senate Bill 507 will expand mediation for out-of-network bills, but financial surprises for patients won't end when it takes effect on Jan. 1.
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.
Dr. Arlo Weltge (Dec. 6, 2017)
Dr. Ray Callas (Senate Bill 507, March 9, 2017)
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)
Balances left on medical bills and unwarranted changes to medication: Those are just two of the ways in which health insurers can and do make life difficult for patients and physicians throughout Texas. Two bills that TMA backed in the 85th Texas legislative session — and that earned Gov. Greg Abbott's signature — won't eradicate those problems in Texas. But they should create some relief from the headaches that those two issues have caused throughout the years.
Building Better Policies
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.:
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.