Texas House Bill HB3348

Texas 2017 - 85th Regular

Caption

Relating to coverage under a preferred provider benefit plan for certain services provided by out-of-network providers; authorizing a fee.

Impact

The implementation of HB3348 introduces notable changes to Texas's insurance regulations, particularly in the Insurance Code. It seeks to establish a more equitable system for the treatment of emergency care claims, particularly emphasizing the creation and utilization of a database that provides certification of the usual and customary charges for services rendered by health care providers. Furthermore, the bill underlines the necessity for transparency in the reimbursement process, as insurers are required to disclose coverage terms clearly and ensure compliance with the newly outlined standards.

Summary

House Bill 3348 pertains to coverage under preferred provider benefit plans for out-of-network services, specifically addressing reimbursement for emergency care provided by non-preferred providers. The bill mandates that insurers cover emergency services rendered by out-of-network providers at the level of benefits equivalent to that of in-network providers, ensuring that insured individuals are not financially penalized beyond their typical copayment or deductible amounts. This policy aims to enhance patient protections in scenarios where individuals might not have the choice to select their healthcare providers during emergencies.

Contention

Discussion around HB3348 may reveal contention regarding the operational impacts on insurance companies and out-of-network providers, with concerns related to the feasibility of determining appropriate reimbursement rates. Some stakeholders in the insurance industry may view the increased obligations as burdensome, particularly regarding the certification requirements and potential adjustments to premium structures for out-of-network coverage. Conversely, advocates for patient rights may contend that the protections offered by the bill outweigh the administrative challenges posed to insurers, highlighting the need for consumer safeguards within the healthcare system.