Texas Senate Bill SB1914

Texas 2019 - 86th Regular

Caption

Relating to the mediation of the settlement of certain health benefit claims involving balance billing by out-of-network laboratories.

Impact

The bill seeks to create a more balanced approach to resolving payment disputes in the health insurance landscape. By establishing mandatory mediation, it protects enrollees from the potentially overwhelming bills associated with out-of-network services. It aims to enhance transparency by requiring providers to disclose network contract statuses and cost expectations before services are rendered, which could lead to more informed decision-making by enrollees. This legislative change is particularly relevant as it addresses growing concerns around unexpected medical bills, which have been a significant financial burden for many families.

Summary

SB1914 is aimed at addressing the challenges associated with balance billing in health benefit claims from out-of-network laboratories. The bill proposes a structured mediation process to resolve disputes between insurance providers and healthcare providers when claims exceed a certain threshold. Specifically, if an enrollee finds themselves liable for more than $500 after applying deductibles and coinsurance for services received from an out-of-network laboratory or other facility-based providers, they may request mediation. This is particularly important for services deemed as emergency care or when the enrollee had limited opportunity to confirm network status prior to receiving services.

Contention

Noteworthy points of contention regarding SB1914 may stem from the balance of power between insurers and healthcare providers. Some stakeholders may argue that the mediation process could complicate or slow down claim settlements, while others may believe that it offers necessary protections for consumers. Additionally, there are pressures for laboratories and facility-based providers to comply with new disclosure requirements, which critics may highlight as potentially burdensome or inadequately enforced post-implementation. Overall, the bill represents an effort to modernize the health claims process in Texas, aiming for fairness in the resolution of disputes as healthcare costs continue to rise.