Texas Insurance Department Adopts Rule on Surprise Medical Billing Waiver

The Texas Department of Insurance (TDI) has adopted a rule outlining the narrow exception to the state’s new surprise billing protections, which apply to health care services provided on or after Jan. 1, 2020.

Senate Bill 1264 protects consumers with state-regulated health plans (about 16% of Texans) from surprise bills in emergencies and in cases where the consumer had no choice of providers. The legislation carves out a narrow exception when a consumer chooses an out-of-network doctor or provider at an in-network facility.

The new TDI rule:

• Clarifies that consumers can waive SB 1264 balance billing protections only in cases where they have a choice between an in-network provider and an out-of-network provider. The waiver can’t be used in an emergency or when an out-of-network doctor was assigned to a case, such as when an anesthesiologist is assigned to a surgery.
• Includes the form consumers must sign at least 10 business days before receiving out-of-network care if the provider wants to balance bill the consumer instead of requesting arbitration or mediation.
• Applies only to state-regulated insurance plans and people with coverage through the state employee or teacher retirement systems. Insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them. (See examples.) It does not apply to large employer-sponsored health plans or Medicare.

The TDI rule is adopted on an emergency basis. The agency soon will post the rule through the normal rulemaking process, which will allow time to accept and consider public comments.

Waiver rule; Wavier form and instructions (fillable version)

Source: TDI

Topics Texas