TMA Testimony by Sara Austin, MD
House Committee on Insurance
House Bill 3102
April 8, 2015
Good afternoon, Chairman Frullo and members of the committee. My name is Dr. Sara Austin, and I am a practicing neurologist in Austin. I also am a member of the Texas Medical Association’s (TMA’s) Council on Legislation. I am here today representing TMA and its more than 48,000 physicians and medical student members. I am testifying today in respectful opposition to House Bill 3102.
Physicians appreciate the spirit of HB 3102, which we believe is to ensure that patients have an understanding of what charges may not be covered by their health plan so they can make an informed decision about their health care. However, this bill mandates actions that do not align well with how health care is delivered in the day-to-day office workflow and will impact timely access to care. In addition, as part of my testimony, I would like to illustrate how what is required under current law should make this legislation unnecessary.
The new House Insurance Committee members may not be aware of Senate Bill 1731 that was passed in 2007. SB 1731 is extensive in the requirements it places on physicians, hospitals, and health plans regarding their responsibilities to patients who request estimates and certain payment information. The passage of SB 1731 in 2007 provided patients, both insured and uninsured, the opportunity to obtain health care estimates from hospitals, physicians, and health plans. Attached you will find a table of the requirements found in SB 1731 for physicians, hospitals, and health plans, along with the oversight requirements of their respective regulatory agencies. (Attachment 1).
The legislation recognized that two groups of patients access services: insured patients and uninsured patients. The bill specifically delineated the two. The delineation is necessary because the amount the patient will pay out of pocket differs depending upon the insurance status of the patient. In addition, the bill recognized that where patients should seek information about what they will owe is dependent upon the patient’s insured/uninsured status.
I will limit my comments to the requirements of physicians under current law.
Under current law, physicians are required to provide, upon request of an uninsured patient, or an insured patient seeking services that are out-of-network, an estimate of charges for any health care service or supply. The timeframe for the provision of an estimate is no later than 10 business days after the request.
In addition, I must provide, at the time of the estimate request and prior to patient evaluation, an explanation of what may impact the amount of the estimate and why the charge or services may vary. Unlike HB 3102 before you today, current law affords physicians much-needed flexibility but at the same time requires us to advise the patient that:
- The request for an estimate of charges may result in a delay in the scheduling and provision of the services;
- The actual charges for the services or supplies will vary based on the patient’s medical condition and other factors associated with performance of the services;
- The actual charges for the services or supplies may differ from the amount to be paid by the patient or the patient’s third-party payer; and
- The patient may be personally liable for payment for the services or supplies depending on the patient’s health benefit plan coverage.
SB 1731, which has been law for seven years, continues to be a useful tool for Texas consumers to obtain information regarding their out-of-pocket exposure for health care services. Texas physicians supported the passage of SB 1731 in 2007 and continue to provide estimates upon request. A recent 2014 TMA Physician Survey has provided insight into how physicians communicate with patients about their fees.
Even though SB 1731 does not require physicians to provide estimates for insured patients (because those will be provided by the insurer), 53 percent of physicians surveyed provide an advance estimate based on the physician’s contract rate and the patient’s responsibility, such as copays, deductibles and coinsurance. It is important to note that estimate amounts will vary from patient to patient, and can vary for the same patient due to what time in the coverage year services are sought and provided. Even more interesting is the fact that 11 percent of all physicians post charges for all or some of the services they offer.
(See survey results below — note, physicians could choose from one or MORE of the disclosure methods. The percentages show the proportion who chose that particular method of disclosure).
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