The Texas Medical Association is fighting a bill working its way through the Capitol that would allow insurance plans to unilaterally determine payment for out-of-network billing.
Senate Bill 1264, by Sen. Kelly Hancock (R-North Richland Hills), is scheduled for a committee hearing Thursday. TMA urges physicians to contact their lawmakers and let them know medicine’s opposition to SB 1264, which was filed with no input from the House of Medicine.
“Ostensibly, SB 1264 is about relieving patients from the shock of surprise medical bills from out-of-network physicians and providers,” TMA President Doug Curran, MD, wrote in an email to member physicians. “But that is a smokescreen for a move that relieves insurance companies and HMOs of accountability for the products they sell to Texas patients, and gives the health plans unilateral power to determine reasonable payments for out-of-network physician services.”
According to a release from Senator Hancock’s office, SB 1264 would “allow medical providers and facilities to directly trigger an existing Texas Department of Insurance (TDI) balance bill mediation program” to negotiate payments with insurers, “while prohibiting them from sending surprise balance bills to customers.” The current mediation process allows patients to mediate many out-of-network balance bills higher than $500.
Per TMA’s analysis, SB 1264 would:
- Relieve insurance companies and HMOs of accountability for the products they sell to Texas patients;
- Remove current patient protections in emergencies and instead place the burden on physicians;
- Give big insurance the ability to control the private health care market by setting what it will pay for covered services; and
- Remove current insurer payment standards.
The TMA instead supports Senate Bill 1591, by Sen. John Whitmire (D-Houston), which also would take the patient out of the surprise billing negotiation process, but would provide a fair method between insurers and physicians for payment. This would be done through an arbitration process in which the amount awarded would be based on the medical case at hand in conjunction with a nonprofit, independent, claims database to create a benchmark for fair market value. House Bill 2967, by Rep. Tom Oliverson, MD (R-Cypress), is the companion bill.
Holding insurance companies accountable for the products they sell and pushing for accurate, up-to-date networks are among TMA’s goals during this legislative session.
The TMA’s Healthy Vision 2025 seeks to draw a roadmap for how legislators can hold insurance companies accountable. Recommendations to the Texas Legislature include:
- Protect physicians’ rights to set their charges and collect outstanding balances;
- Support the continued use of mediation for patients to resolve surprise bills;
- Require health plans to create and maintain adequate networks;
- Require health insurance companies and their agents to explain in plain language exactly what a patient’s health plan will and won’t cover, as well as the patient’s financial responsibility, before they purchase a policy;
- Prohibit insurance plans and pharmacy benefit managers from switching patients’ prescription drugs for nonmedical reasons; and
- Prohibit plans from terminating physician contracts without cause.
TMA members can support these goals by contacting their lawmakers or participating in the final two First Tuesdays at the Capitol advocacy events April 2 and May 7.