The Updated Skinny on Texas’ Surprise Billing Law
By Joey Berlin

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The Texas Medical Association has updated its white paper on Texas’ law for settling out-of-network billing disputes involving state-regulated health plans.

The eight-page white paper, first released last December, covers the ins and outs of Senate Bill 1264, the 2019 legislation now in effect. SB 1264 took patients out of the middle of surprise-billing disputes between certain out-of-network physicians and state-regulated health plans, allowing them to settle those disputes through an arbitration process similar to the one used to settle salary disputes in Major League Baseball.

The white paper update comes after the Texas Department of Insurance  adopted a final rule touching on exceptions to SB 1264’s general ban on balance billing for out-of-network services the law covers. SB 1264 prohibits balance billing except in certain circumstances, which include required notice and disclosure.

The newly amended rules include these changes that TMA requested:

  • Legal representatives or guardians of a patient may be the people to agree to an out-of-network physician’s required notice and disclosure of a potential balance bill; 
  • A physician may delegate the record-keeping of that notice and disclosure statement by allowing a practitioner’s “agent or assignee” to maintain a copy of the statement. Also, the statement only has to be maintained if the practitioner provides the medical service or supply at issue and sends a balance bill.

You can read the complete adopted rule on page 4,204 of the June 19 Texas Register.

Last Updated On

July 08, 2020

Originally Published On

July 08, 2020

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Joey Berlin

Associate Editor

(512) 370-1393
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Joey Berlin is associate editor of Texas Medicine. His previous work includes stints as a reporter and editor for various newspapers and publishing companies, and he’s covered everything from hard news to sports to workers’ compensation. Joey grew up in the Kansas City area and attended the University of Kansas. He lives in Austin.

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