180.028 Full Explanation of Noncontracted Payment Limits

180.028

Full Explanation of Noncontracted Payment Limits: Texas health insurers who apply noncontracted payment limits other than copayments, coinsurance, and deductibles should be legally required to clearly inform patients, at the time of subscription or enrollment, that the patient may be responsible for charges that exceed the insurer's payment limits. Texas insurers should be prohibited from misrepresenting their payment limits on noncontracted services in a manner that implies improper billing by physicians and from applying noncontracted payment limits other than copays, coinsurance, and deductibles (CSE Rep. 5-A-03; amended CSE Rep. 1-A-13).

Last Updated On

October 07, 2016