Texas Bar Journal: Insurance Law
By Ryan Brannan, see PDF
When it comes to insurance legislation, there is an old adage: If you aren’t talking about accessibility and affordability, no one is listening. That tenet, coupled with the pressing public policy issues of rising health care costs and the impact of Hurricane Harvey, proved to be central motifs of passed legislation for the 86th Texas Legislature. With so many insurance-related bills passing this session, the article below is to be viewed as a summary of the more significant legislation. All bills are effective September 1, 2019, unless otherwise indicated.
Rising Health Insurance Costs
The Legislature attempted to tackle rising costs primarily through balance billing and price transparency legislation.
Balance Billing and Related Legislation
SB 1264 prohibits all non-network facility-based providers at network hospitals and all non-network emergency care providers from sending surprise balance bills to consumers. The legislation requires health plans, including preferred provider organizations, or PPOs, exclusive provider organizations, or EPOs, and health maintenance organizations, or HMOs, to pay reasonable or agreed-upon amounts to out-of-network emergency care and facility-based providers. The bill also allows providers to dispute payment amounts through the existing Texas Department of Insurance, or TDI, mediation program. Consumers will still be responsible for their applicable copay, coinsurance, and deductible amounts.
SB 1742 amends Chapter 843 and Chapter 1301 of the Texas Insurance Code, regarding HMO and health benefit plans respectively, to clearly identify which radiologists, anesthesiologists, pathologists, emergency physicians, neonatologists, and assistant surgeons are in-network at network facilities. The bill makes significant changes to preauthorization and utilization review, requiring at least 60 days’ notice to providers for changes or new requirements and creates an interim committee to make recommendations on increasing transparency and improving patient outcomes. HB 3911 expands the authority of the insurance commissioner to examine plans for network adequacy by expanding Section 1301.0056 of the Texas Insurance Code to apply to PPOs—the section already applied to EPOs. Notably, the bill changes a “may” to a “shall,” requiring these examinations to be performed at least every three years or more as determined by TDI.
SB 1037 prohibits a consumer credit reporting agency from furnishing a consumer report that includes information on a medical collection account when the consumer had health insurance at the time services were received and the collection relates to billing for an outstanding balance owed to an emergency care provider or a facility-based provider for an out-of-network benefit claim. SB 1037 went into effect immediately upon the governor’s signature on May 31, 2019.