Provides for mediation of the settlement of out-of-network health benefit claims involving balance billing
Impact
If enacted, HB 369 will affect how out-of-network medical claims are settled, requiring entities involved to engage in mediation before pursuing collection for charges exceeding the specified amount. The provisions encourage transparency, as healthcare providers must disclose potential out-of-network costs prior to the provision of services. The bill also establishes the Department of Insurance's role in regulating the mediation process and underscores the necessity for fair consumer information protocols regarding mediation services and related costs.
Summary
House Bill 369 introduces a structured process for the mediation of out-of-network health benefit claims that involve balance billing amounts exceeding $500. The bill outlines the circumstances under which an enrollee can request mediation and mandates participation from relevant parties, including health benefit plan administrators and healthcare providers. This legal framework aims to provide consumers with a more predictable and manageable means to resolve disputes regarding unexpected medical bills, particularly in emergency situations where out-of-network services are rendered.
Sentiment
The overall sentiment around HB 369 appears to be supportive among consumer advocacy groups who contend that it enhances transparency and cuts down on surprise medical bills that can burden patients financially. However, some criticism may arise from insurers and providers concerned about the implications mediation could create in claim adjudication and payment processes. Notably, the requirement for mediation could lead to extended timeframes for dispute resolutions, which could frustrate both insurers and providers looking for rapid closure.
Contention
A noteworthy point of contention is the balance between protecting consumers from excessive out-of-network costs and the potential burdens placed on healthcare providers and insurers resulting from mandatory mediation. There is a concern that the mediation process may not only slow down resolution timelines but may also create new administrative costs for providers who must now prepare for and participate in these mediations. Additionally, questions about the qualifications of mediators and the parameters around bad faith mediation practices add layers of complexity to the proposal.
Relating to mediation of the settlement of certain out-of-network health benefit claims involving balance billing for members of the Teacher Retirement System of Texas.