TMA Supports Bill to Improve Balance-Bill Mediation

Testimony by Ray Callas, MD

Testimony in Favor of Senate Bill 507 by Sen. Kelly Hancock (R-Fort Worth), Balance-Bill Mediation
Texas Senate Business and Commerce Committee 

March 9, 2017

Thank you chairman and members of the Senate Business and Commerce Committee for having me to testify today. My name is Ray Callas. I am an Anesthesiologist from Beaumont, and today I am testifying on behalf of the Texas Medical Association (TMA) and our more than 50,000 physician and medical student members.  I also serve as the chair on TMA’s Council on Legislation, and today I will be testifying “for” SB 507 as substituted.

Just as a recap, balance or “Surprise bills” may occur when a person insured under a preferred provider organization (PPO) unexpectedly receives services out of network. The mediation process for out-of-network billing is working well in the state of Texas and has been a tremendous patient protection with the narrowing of insurance networks.   

We have seen growth in the utilization of the mediation process grow from 14 requests in 2010, to 1,677 requests in 2016. Therefore, TMA is supportive of its expansion to all out-of-network health care providers at an in-network facility along with emergency care.  Additionally, we are pleased to see that the legislation maintains the $500 threshold as well as personal responsibility of the patient.  

Because mediation is working, we are happy to see the mediation process protected, as the initial informal conference call is where 95 percent of disputes are resolved. We feel maintaining this process is in the best interest of the patient to have a timely resolution of an out-of-network balance bill.  

Furthermore, requiring both the insurance company and the health care providers to notify the patient on how to request mediation, using simple, standard language on both the explanation of benefits and billing statements is better for the patient. 

I would also add that we would be very interested in seeing more oversight on health plans maintaining accurate online directories of what health care providers are in-network.  Currently, a plan only has to update this monthly and changes to make this more frequent would allow for better patient and physician education, and help prevent surprise bills altogether.  

With this additional oversight, stronger enforcement of current network adequacy laws would also prevent the rise of extremely narrow networks and allow for a better access to care for Texas patients.  

We look forward to continuing our work on this legislation and I thank you for your time.  

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Last Updated On

April 27, 2018

Originally Published On

March 09, 2017