Insurance & Benefits

Texas’ Balance Billing Legislation May Be Threatened by Loophole

Consumer advocates are worried that a proposed rule could undo the protections in Texas’ balance billing legislation. After a law was passed this summer to keep Texas patients out of arbitration between providers and insurers when there are surprise medical bills, some worry that a loophole in the legislation will be used to confuse patients and increase balance billing.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, says that the Texas Medical Board is proposing a rule to implement the law that would expand the use of a section of the law for patients who knowingly go out-of-network for nonemergency care. The section of SB1264 is intended to be used when patients are set on using a specific doctor, but Pogue worries the new rule would require all providers to give the patients the form during emergency care, which could result in them signing away the protection the law provides, reports Kaiser Health News.

But the Texas Medical Board says it is using its “rule making authority to strengthen the protections against balance billing for nonemergency health care or medical services.” The proposed rule would give patients a five day “cooling off” period to give patients time to consider their options and standardizes a form for providers to disclose options to patients. The TMB maintains that it would not require the use of this form, but it would be used by physicians who want to collect a higher rate that insurance would normally give them.

But the desire of physicians to get higher rates is exactly what worries critics of the proposed rules. North Richland Hills Republican Representative Kelly Hancock, who co-sponsored SB1264, told Kaiser that he hasn’t seen a bill go through a rule-making process this complicated. He thinks it may be because balance billing was a significant source of income for certain out-of-network providers. “We are trusting the process, but we are also verifying the process to make sure we get the end result we are looking for,” Hancock told Kaiser. “And, frankly, what I think those who support the legislation voted for.”

Associate director for the AARP of Texas told Kaiser that he is worried that the rules are too vague and will cause confusion for patients. “Other states that have addressed the surprise medical bill issues haven’t created an exception for nonemergency, out-of-network physicians like we did,” Hutson said.

The proposed rules will be discussed on Dec. 6 by the board, and could be adopted then. Read more from Kaiser Health News here.


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