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 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.
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.
The Texas Department of Insurance (TDI) 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.
The federal government should take a balanced approach to surprise medical bills that includes commercially reasonable upfront payments and independent arbitration, the Texas Medical Association and many other medical societies are telling key members of Congress.
Arguably one of the biggest issues Texas lawmakers tackled this session was surprise billing, as they vowed to protect patients from receiving medical bills for care not covered by insurance.
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)
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.:
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.