Relating to mediation or arbitration of certain billing disputes between health benefit plan issuers or administrators and out-of-network facilities.
Impact
This bill is set to impact how billing disputes are handled within Texas healthcare. By mandating quicker resolutions through arbitration, it aims to alleviate the prolonged and often contentious disputes that can arise when patients receive care from out-of-network providers. The legislation specifies that any necessary payments following an arbitration decision must be settled promptly, within 30 days, further emphasizing efficiency and accountability in the claims process.
Summary
SB701 is a legislative proposal aimed at streamlining the resolution of billing disputes between health benefit plan issuers and out-of-network facilities through mediation and arbitration. The bill amends current statutes within the Texas Insurance Code, adding provisions that define unacceptable practices during the mediation process, such as failing to provide necessary information for mediation or not sending an authorized representative to negotiate. If either party participates in bad faith, the opposing party has the right to request arbitration under newly defined conditions.
Contention
While proponents argue that SB701 will facilitate smoother interactions between providers and insurers, some stakeholders may raise concerns regarding the fairness of the mediation and arbitration process. Specific points of contention could include the definition of 'bad faith' in negotiations, as well as whether the expedited arbitration process could adequately protect patients and providers alike. The bill is designed to go into effect in 2025, with claims related to services provided on or after January 1, 2026, which gives interested parties time to prepare for the changes.
Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.