Texas House Bill HB3814

Texas 2017 - 85th Regular

Caption

Relating to payment standards for preferred provider benefit plans to reduce balance billing of insureds for out-of-network health care services.

Impact

The enactment of HB3814 is expected to have significant implications for both patients and healthcare providers. Patients will benefit from reduced financial risks associated with balance billing, as their exposure to out-of-pocket expenses for out-of-network services will be more predictable and limited. For healthcare providers, especially those who frequently operate outside of insurance networks, the new payment standards could ensure fair compensation and encourage collaboration with insurers to offer wider access to services covered under these plans.

Summary

House Bill 3814 addresses payment standards for preferred provider benefit plans, specifically aiming to mitigate the practice of balance billing for out-of-network healthcare services. The bill introduces a requirement for insurers to pay out-of-network providers at least the 'usual and customary charge' for covered services, which is defined as 135% of the average maximum allowed charge for similar services in the same geozip area. This adjustment aims to protect insured individuals from unexpected high bills resulting from receiving care from providers not in their insurance network.

Contention

While the bill has garnered support for its consumer protective measures, there may be concerns from insurers and some medical providers regarding the standard for 'usual and customary' payments. Insurers may fear that the increased payment obligations could lead to higher premiums for all insured, while out-of-network providers might have differing opinions on whether the set rates adequately compensate for their services, potentially leading to disputes and further discussion on healthcare reimbursement practices.