TMA Physicians and Legislators: “Patients Have a Right to Know”

March 25, 2009  


Pam Udall 

phone: (512) 370-1382 
cell: (512) 413-6807 
Pam Udall 

Brent Annear
phone: (512) 370-1381 
cell: (512) 656-7320 
Brent Annear  

The Texas Medical Association (TMA)  joined with state legislators to launch initiatives today that would make using health insurance better and much easier for Texas patients.

The problem: Too often patients do not understand their health insurance information and cannot easily find the answers.

"We believe our patients have the right to know what's covered in their insurance," said Josie R. Williams, MD, TMA's president. "Our patients also have the right to know which doctors and hospitals are in their network, how much extra they will have to pay for the health care services they receive, and why they have to keep paying more for health insurance."

That is why TMA launched its grassroots outreach campaign, Patients' Right to Know. The goal of the campaign is to engage Texas patients in the effort to pass legislation that would reform health insurance.

Several state lawmakers have introduced important legislation that will ensure that patients have the right to accurate and current information on copays, deductibles, and health plan networks to make good health care decisions.

The first piece of legislation to bring needed improvements to the health insurance industry is the Health Insurance Code of Conduct Act of 2009. The measure was filed by Sen. Kip Averitt (R-Waco) and Rep. Craig Eiland (D-Galveston) in the Senate and the House as Senate Bill 1257 and House Bill 2750, respectively.  

The Health Insurance Code of Conduct Act of 2009 would:

  • Require health plans to receive input from an outside party before they could cancel the insurance of a very ill or injured patient who starts to run up high medical bills;
  • Prevent health plans from increasing the cost of insurance for no reason;
  • Help patients and employers determine how much of their money the insurance companies actually spend on health care, vs. advertising or big bonuses, or profits;
  • Prevent health insurance companies from selling doctors' contracts behind their backs (they're fooling the doctors and making patients pay for it); and
  • Make health insurance companies stop trying to tell patients that some doctors are better than others based on the insurance claims. That's like saying a restaurant's food is good or bad just by looking at the bill at the end of the meal.

"We think it's about time health insurance companies treated our patients like valued customers, and keep the promises they make," added Dr. Williams.

For many people, understanding which insurance to buy is difficult. So physicians wonder, what if patients could understand what's in their health insurance policy as easily as they can see what's in a can of soup? What if patients could compare two different health plans as easily as they can compare the calories in two different jars of peanut butter?

TMA's health insurance label plan, filed by Sen. Kirk Watson (D-Austin) and Rep. Senfronia Thompson (D-Houston), would do just that. SB 815 and HB 1932 would require a standardized format for health plan marketing materials that allows an "apples-to-apples" comparison of health insurance coverage.

"Buying health insurance today is very complicated," said Dr. Williams. She added that big insurance companies offer dozens of different plans, and cover different things. Patients' out-of-pocket costs can vary wildly. "It is almost impossible to compare what each plan might mean to patients, their family, or business owners' employees, and we think it's time big insurance makes this simpler for patients."

The Patients' Right to Know campaign calls on patients and physicians to help make health insurance more accessible and transparent. Among other tools, TMA created, a Web site with a grassroots action center where patients can write their legislators in support of health insurance reform bills. Educational materials will be displayed in physician offices to inform and engage patients.

Other health insurance reform bills being filed:

  • Sen. Wendy Davis (D-Fort Worth) filed SB 1611, which would prohibit insurers from arbitrarily revoking a patient's health insurance coverage. The companion legislation to SB 1611 is HB 1748 by Rep. Todd Smith (R-Euless). Senator Davis also filed three bills that would require health insurers to disclose how they spend the patient's premium dollar. Those bills are SBs 1155, 1156, and 1158.
  • Rep. Carol Alvarado (D-Houston) filed HB 3120, relating to the maximum allowable premium rate increase for small-employer health benefit plans.
  • HB 223 by Representative Eiland and SB 714 by Sen. Leticia Van de Putte (D-San Antonio) would regulate how a physician's contract information is sold, leased, or shared among health insurance companies.
  • HB 1392 by Rep. David Leibowitz (D-San Antonio) and SB 1396 by Sen. Robert Deuell, MD (R- Greenville), would require health insurance companies to use scientifically valid criteria to evaluate physicians' performance and disclose those criteria in advance.
  • HBs 1369 and 1370 by Rep. Eddie Rodriguez (D-Austin) would provide transparency about how insurers calculate patients' coinsurance, and allow patients to accurately predict their out-of-pocket costs.
  • SB 901 by Senator Deuell, MD, relates to the collection of information concerning data mining and pattern recognition by health plan benefit insurers, and gives the Texas Department of Insurance the authority to require health plans to report how they use this information.
  • HB 389 by Rep. John Zerwas, MD (R-Simonton), clarifies requirements for expedited credentialing of physicians by health plans.
  • HB 390 by Representative Zerwas, MD, and SB 39 by Sen. Judith Zaffirini (D-Laredo) would require health plans to pay patients' routine medical costs when participating in a clinical trial.
  • HB 1342 by Rep. Jose Menendez (D-San Antonio) and SB 863 by Sen. Chris Harris (R-Arlington) require health plans to provide pertinent patient coverage information at the time of service.

TMA is the largest state medical society in the nation, representing nearly 44,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. TMA's key objective since 1853 is to improve the health of all Texans.

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