Texas’ New Surprise Medical Bill Law Goes into Effect on Jan. 1

Some Texans will have new consumer protections against surprise medical bills when a new law becomes effective on Jan. 1, the Texas Department of Insurance reported.

Patients get surprise medical bills when they get care from a doctor, lab, or other provider outside their health plan’s network. This most often happens in two situations:

• Someone has surgery or gets treatment at an in-network hospital or facility but gets care from an ER doctor, anesthesiologist, radiologist, or other provider who doesn’t have a contract with their health plan.
• Someone gets treatment for an emergency at an out-of-network hospital or emergency facility.

The new law, enacted from legislation passed this year — Senate Bill 1264, bans doctors and providers from sending balance bills to patients in those cases. Instead, health care providers can apply for arbitration or mediation to resolve payment issues with insurers over those bills. The new law keeps consumers out of the middle of those disputes.

The new law applies to state-regulated insurance plans and people with coverage through the state employee or teacher retirement systems – or about 16% of Texans. Insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them. It does not apply to many fully insured employer-sponsored plans or Medicare.

The new law applies to medical services received on or after January 1. It law applies in emergencies and situations where the insured didn’t select the doctor (such as the radiologist who reviewed an X-ray).

Source: TDI

Topics Texas Legislation