The TMA Board of Trustees has approved and sent to the TMA House of Delegates a plan to preserve physicians' right to bill for their services. Quite a few other states, some members of Congress, and the Obama administration have enacted or proposed legislation that would severely limit or prohibit physicians from billing patients for services provided out of network. The board-appointed Task Force on Balance Billing, which included hospital-based physicians and representatives of several other specialties, devised the plan.
Board member Keith Bourgeois, MD, a Houston ophthalmologist, chaired the group. Striving to "align [physicians] with the best interests of our patients" and "address the behaviors of insurers that finance health care and apply to all practitioners involved in patient care," the report recommends:
- That TMA "ardently pursue legislative goals" in existing policy designed to "hold insurers accountable for their actions";
- Extending mediation for out-of-network billing disputes to patients at all facilities — for all practitioners and all facilities — while maintaining the $500 threshold for mediation;
- "Mandatory increased state agency oversight of insurers that are often brought to mediation";
- For planned surgical procedures or labor and delivery, "development of a standard form for physicians to disclose to patients the identity of other physicians or nonphysician practitioners typically utilized in the facility"; and
- Continued monitoring of current and proposed laws that rely on large billing databases to set benchmarks or billing standards.
TMA expects Texas insurance companies and their allies to push a balance billing ban in the 2017 legislative session. TMA's plan involves extensive public and patient education on insurance industry tactics — narrow networks and arbitrary "maximum allowables" — that increase the likelihood of patients needing services out of network and push more charges onto the patients.
Action, March 15, 2016
Last Updated On
April 27, 2018