TMA Lays Out Balance Billing Plan to Senate Panel

Just days after the TMA House of Delegates adopted TMA's plan to preserve physicians' rights to bill for services and protect patients from surprise bills, TMA Council on Legislation Chair Ray Callas, MD, presented it to the Senate Committee on Business and Commerce.

The major planks include:  

  • Mandatory increases in state agency oversight of the adequacy of insurer networks, especially for insurers often brought to mediation by patients. (This point was particularly well received by Sen. Charles Schwertner, MD [R-Georgetown].)
  • Expand the current $500 balance bill threshold for mediation to include all out-of-network physicians, other health care professionals, facilities, and vendors.
  • Prior to any preauthorized elective services, require the insurer to inform the patient "about the network status of the facility-based physicians and others who may participate in their care and bill for services." Similarly, physicians and providers should use a standard form to tell patients which physicians and providers who may be involved in their care "typically practice in the facility where the planned services … will occur."
  • Require insurers selling PPOs to include "a clear and conspicuous notice regarding the implications of using or receiving services from an out-of-network physician … and the potential for balance billing" on their websites, policy documents, and directories.
  • Require insurance brokers and agents to educate consumers on the inherent limitations of the plans they buy, especially their out-of-pocket responsibilities for care provided both in and out of network. 

That same day, TMA also unveiled its first patient education piece on the root causes of unexpected medical bills. Download "Why Did I Get That Medical Bill?" from the TMA website and share it.

For more about TMA's balance billing efforts, read "No More Surprises" in the May 2016 issue of Texas Medicine.  

Action, May 16, 2016

Last Updated On

April 27, 2018

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