Legislation seeks to end surprise billing for most insured Texans

Texas lawmakers have introduced legislation designed to end surprise billing for most state residents with health insurance coverage, according to a Houston Chronicle report.

Six things to know:

1. The legislation, introduced Feb. 28 by state Sen. Kelly Hancock, R-Fort Worth, and state Rep. Trey Martinez Fischer, D-San Antonio, is meant to protect patients from high, unexpected bills after receiving care from an out-of-network provider at an in-network facility.

2. Texas already has a mediation program designed to help patients with surprise medical bills by working with the health insurance company and the healthcare provider to reach an agreement on the amount charged by the provider, the amount paid by the insurer to the provider, and the amount paid by the patient.

3, But Mr. Hancock said in a news release that thousands of Texans still receive unexpected surprise medical bills annually, and the new legislation would leave patients out of the middle of disputes between the service provider and insurer.

4. The news release states that the legislation would leave it up to the service provider and insurer to seek mediation.

5. It would also primarily ban providers from billing people insured through state-regulated health plans for services received at an in-network facility above their out-of-pocket expenses as defined under the insurance coverage.

6. Additionally, the legislation includes an opt-in provision for people under federally regulated, self-funded Employee Retirement Income Security Act health plans.

 

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