TMA Weighs In On COVID-19 Surprise Billing, Insurance Premiums, and More
By Joey Berlin

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The COVID-19 pandemic is creating new issues for the Texas Legislature to examine, as well as new wrinkles on old issues.

As always, the Texas Medical Association is pushing state lawmakers to do right by patients and physicians next year at the Capitol.

TMA submitted written testimony Tuesday to the House Committee on Insurance, providing details and recommendations on price gouging, surprise medical bills, health insurance premiums, and more.

TMA and 16 other medical organizations submitted written testimony to the committee addressing the following questions:

  • How prevalent is price gouging related to COVID-19 testing, and what are state agencies doing to monitor it?
  • What steps are being taken to prevent surprise medical billing associated with COVID-19 treatment? What steps can patients take to avoid surprise medical bills?
  • How many business interruption claims have been filed during the COVID-19 pandemic? Did policyholders report issues with being unaware of pandemic-related exceptions to coverage under these policies?
  • What is the anticipated impact of the COVID-19 pandemic on health insurance premiums and the health insurance market moving forward? 

TMA and the other associations offered the committee information on existing state and federal protections from price gouging. The letter recommended that before the committee considers action to address COVID-19 testing price gouging, it should evaluate the effectiveness of current protections. “It is important for the committee to remember that not all price variations or higher pricing constitutes price gouging,” TMA noted.

On surprise billing, TMA urged lawmakers to avoid cost-shifting from health plans to patients or physicians, “both of whom are facing strained resources as they battle the virus.” The letter makes several recommendations to bolster existing state network adequacy regulations, including requiring PPOs to verify their networks’ ability to handle COVID-19 increases; requiring the Texas Department of Insurance (TDI) to increase network adequacy requirements to meet the increased demand during COVID-19; and encouraging TDI to conduct network adequacy examinations during the pandemic.

TMA’s testimony noted misinformation on business interruption insurance “spewing from insurers, their defense counsel, and brokers to discourage business interruption claims from being filed.” TMA anticipates litigation will be needed to test whether insurers can legitimately exclude pandemics from business interruption claims, as they have attempted to do since the pandemic started.

TMA’s written testimony also pointed out that while COVID-19 has shaken the financial stability of physician practices and hospitals, commercial insurance companies have “significantly increased their earnings.” TMA urged the committee to keep a close eye on insurance premiums to ensure all Texans have affordable health coverage, as well as adequate insurance networks.

Health plans are expected to set premium rates according to their expected costs for the future, and COVID-19 must affect these forecasts, TMA wrote.

To diversify America’s supply chain, lawmakers aim to manufacture medical supplies domestically,” the letter says. “While this may protect access to these supplies, they will also dramatically increase health care costs. Because patients delayed care in 2020, there will be pent-up demand for care in 2021. This along with COVID care and COVID vaccine costs could also increase health care costs. These increases could be passed on to patients with increased premiums and/or cost share.”

Other organizations signing on to TMA’s testimony include the Texas Pediatric Society, the Texas Radiological Society, the Texas Orthopaedic Association, and a number of other specialty societies.

Last Updated On

September 09, 2020

Originally Published On

September 09, 2020

Joey Berlin

Associate Editor

(512) 370-1393
JoeyBerlinSQ

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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