New Texas Bill Restricts “Balance Billing” by Certain Providers

Balance Billing

During the 86th Texas legislative session, Senate Bill 1264 was recently passed, placing restrictions on certain out-of-network providers relating to “balance billing”. The bill also establishes a process by which health providers can resolve disputes regarding payment. This way, Texan’s will be less likely to be met with surprise medical bills due to out-of-network providers not being able to agree on treatment prices with their insurance company. The bill passed the senate with a 29-2 vote with two physicians on the dissenting side. The bill is effective September 1, 2019 and applies to services provided on or after January 1, 2020.

Surprise medical bills (also known as balance bills) occur when patients are invoiced for medical costs leftover after insurance companies dispute with healthcare providers. This often comes as a “surprise” because patients don’t realize that they associated with an out of network provider such as a physician assistant who may not be in network.

In terms of fleshing out the details, the bill protects patients from out-of-network costs during times in which the go to an in-network hospital. This way, patients will only be responsible for in-network rates. By leaving out-of-network disputes to be handled by insurers and the health care providers, Texas patients (who have for years been devastated by these charges) can rest easier knowing that they won’t be hit with a surprise bill. 

SB 1264 also establishes a dispute resolution process for out of network claims and decisions to be made regarding payment between health plans and providers. Within 30 days of the request, out of network providers and health plans must participate in an informal settlement teleconference to reach a resolution. If no decision is met, the bill provides for mediation or arbitration depending on the type of provider. These programs are established by the Texas Department of Insurance (TDI); they are to adopt the rules and procedures by which the program is implemented (such as a web portal to request mediation/arbitration). Although the bill may allow for an arbitration process that takes the patient out of the dispute, the patent is still responsible for deductibles, co-payments and cost sharing methods.

In an increasingly more expensive healthcare process, this seems to be a step in the right direction for Texas. Looking towards the future, it will be interesting to see how these procedures will operate once developed. If there’s anything to take from this law, it’s that it will at least give some transparency to patients on what they will be billed for.

If you have been injured and the medical bills are piling up, don’t wait to speak to a personal injury lawyer in Arlington, TX about your legal options for compensation.

Thanks to Brandy Austin Law Firm, PLLC for their insight into personal injury claims and medical bills.