Surprise Billing Records Request Could Make Physicians’ Personal, Financial Data Public
By David Doolittle

Cleaners

If you recently participated in an independent dispute resolution (IDR) process created by Texas’ surprise billing law – Senate Bill 1264 – some of your personal and financial data could be made public through an open-records request filed with the Texas Department of Insurance (TDI).

The clock is ticking to file an objection with the Texas Attorney General’s (AG’s) office to protect some of your information.

On Nov. 5 TDI notified health plans, physicians, and providers (or their representatives) who participated in SB 1264’s IDR processes of a request filed by a media outlet seeking “records showing the outcome of all Surprise Medical Bill cases filed with TDI for [5/22/2020 – 10/22/2020], both arbitration and mediation.” 

Some examples of the information sought include:  the names of the health plan and provider involved in the IDR process; whether arbitration was requested and who requested it;  originally billed amount, what the plan paid, disputed amount, the patient’s share, the final offers by the health plan and the provider, and the “reasonable” amount ultimately determined in the dispute resolution process.

The AG’s Office is reviewing the open-records inquiry and will issue a decision in the coming weeks on whether TDI is required to release the information under state law.  

“Generally, the Public Information Act (the ‘Act’) requires the release of information, but there are exceptions,” TDI’s notice says.  

If you are part of the affected group that received the TDI notice, you have the right to identify exceptions and submit objections to the attorney general regarding the release of your records; however, you are not required to do so.

Objections must be filed no later than Nov. 19, the 10th business day after the date the TDI notice was received. 

“If [affected plans, physicians, or providers] fail to take timely action, the attorney general will more than likely rule that [their] records must be released to the public,” says the notice, which provides more details on how to file objections

If you’re interested in filing an objection, the Texas Medical Association’s Office of the General Counsel recommends you consult your privately retained counsel for assistance. TDI’s notice includes specific criteria for submitting an objection to the attorney general and lists some commonly raised exceptions.

TMA will continue to monitor this open-records request and its impact on the SB 1264 IDR processes. 

Throughout the 2019 Texas legislative session and the SB 1264 TDI rulemaking process, TMA emphasized the importance of including meaningful confidentiality protections in order to encourage the use of the IDR processes created under the bill. 

For more information on TMA’s regulatory advocacy on the confidentiality provisions of SB 1264, see pages 22-24 of TMA’s comments to TDI’s proposed SB 1264 arbitration rules.

Last Updated On

November 12, 2020

Originally Published On

November 10, 2020

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David Doolittle

Editor

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Dave Doolittle is editor of Texas Medicine and Texas Medicine Today. Dave grew up in Austin, where he attended culinary school as well as the University of Texas. He spent years covering Central Texas for the Austin American-Statesman newspaper. He is the father of two girls, a proud Longhorn, and an avid motorsports fan.

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