Narrow, inadequate insurance networks can mean little or no access to critical services and result in balance bills when patients least expect them, particularly after an emergency.
“My responsibility as a patient’s physician is to know the risks of administering anesthesia, not administering their personal insurance plan,” said Beaumont anesthesiologist Ray Callas, MD.
“If I’m out of network, but I’ve tried time and again to negotiate with networks and I still can’t get in, I believe insurance should accept some of the responsibility for that bill,” he said.
To Dr. Callas’ point, more than 300 of Texas’ 407 hospitals do not have a single emergency physician in-network with at least one of three major plans. And that’s when patients end up with balance, or surprise, bills. Patients and physicians, also find themselves at the mercy of insurers that publish inaccurate network directories, confuse patients about their coverage, and constantly change their rules and procedures.
The Texas Medical Association’s Healthy Vision 2025 — released this week — seeks to draw a roadmap for how legislators can hold insurance companies accountable for the products they sell to patients. 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.
How can you get involved?
Last Updated On
February 07, 2019
Originally Published On
January 31, 2019