Two newly developed TMA resources examine how insurance plans' network designs and payment decisions are leaving many Texans with "surprise bills" for health care services.
Pass-through billing occurs when an ordering physician requests a service and bills insurance for it but does not perform the service, nor do those under the physician’s direct employ. Insurance companies generally forbid this practice.
The Federal Register published Medicare's 2017 final fee schedule rule on Nov. 15. It updates payment policies and rates for services furnished under the Medicare Physician Fee Schedule on or after Jan. 1, 2017. Although the original proposed rule included an expected fee schedule cut, the final rule increases the fees by a very small amount, less than one-quarter of 1 percent.
TMA’s Hassle Factor Log® helps you resolve insurance-related problems. TMA meets regularly with Medicare, Medicaid, health plans, and large insurers to discuss the specific problems that you bring to our attention.
Physicians and patients are tired of the administrative roadblocks that came with the expansion of Medicaid managed care in Texas and the toll they take on access to care. Thanks to advocacy by the Texas Medical Association's Medicaid Congress and cooperation from new Medicaid leadership, relief may be in sight.
Some Texans receive medical bills they did not anticipate, even though they have health insurance. Their insurance might not cover that care or provide as much benefit as they assumed.
More On Surprise Bills
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