Transparency in Prior Auth and Physician Referrals

TMA Testimony by John Flores, MD

House Insurance Committee
House Bill 3828 by Rep. Carl Sherman

April 16, 2019

Thank you, Mr. Chairman and committee members, for allowing me to testify today. My name is Dr. John Flores, and I am an internal medicine physician from Carrollton. Today I am testifying on behalf of the Texas Medical Association and its nearly 53,000 members FOR House Bill 3828.

We want to thank Representative Sherman and LaVonda Russell on his staff for working with us on this legislation.

TMA believes that if a health plan requires a health care service to go through prior authorization review, the information submitted on the standard prior authorization form could be put to good use in helping patients beyond authorizing their medical care.

When a patient is preauthorized to receive a health care service scheduled at a facility, the health plan should use the information on the form to inform the patient of the network status of any physicians or health care providers who may be involved in the preauthorized care. The health plan also should use the information to tell the patient what level of coverage the plan will be provide and what the patient’s financial responsibility will be to all physicians and providers.

The information that we, as physicians, provide the health plan is more than enough to enable the plan to notify patients of this valuable and necessary information. This financial and network information could prevent surprises in billing and allow the patient to better plan for his or her upcoming medical care.

Additionally, this legislation would require that, for elective health care services, a referring physician inform a patient that the physician or provider to whom the patient is being referred may be out of network.

Thank you for allowing me to testify today, and I am happy to answer any questions.

86th Texas Legislature Letters and Testimonies

TMA Legislative main page

Last Updated On

April 15, 2019

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