The Truth About Balance Billing

A pair of newly developed TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services. 

Inadequate and limited physician networks that insurers sell today are leaving patients with unpaid bills and making the news. Unfortunately, when Texas consumers most need coverage, especially in emergencies, they are discovering the limitations of the coverage they have purchased. The consumer is no longer satisfied with the not-very-well-explained, varying levels of savings that insurance network products create, especially if that means a greater financial burden in emergencies. Yet, despite network shortcomings, consumers do not want to be left without the choice of managed care health plans that offer network benefits.

A new TMA white paper, "Putting the Pieces Together: Network Inadequacy and Unfair Discrimination in Insurance," explains how insurers limit their losses at the expense of the consumer. It also offers health policy solutions that will provide insurance consumers the opportunity to buy the coverage they expect and demand.

TMA staff has also prepared a detailed spreadsheet of network information gathered from Blue Cross and Blue Shield of Texas, Humana, and UnitedHealthcare health plans as of December 2014. To use the spreadsheet: 

  • Click on the tab for the individual carrier at the bottom of the spreadsheet to access the information for that individual carrier. 
  • You may sort by hospital/facility, city, county, or provider(s) in each of these specialties: anesthesiology, pathology, radiology, and/or ER physician/group. 

Action, March 2, 2015

Last Updated On

April 27, 2018