Texas House Bill HB2035

Texas 2021 - 87th Regular

Caption

Relating to utilization review of emergency care claims under health benefit plans.

Impact

The enactment of HB2035 is expected to enhance protections against wrongful denials of emergency care claims, thereby improving non-discriminatory access to essential healthcare services. Insurers are mandated to comply with detailed review procedures that include evaluations by qualified emergency medicine professionals. This level of oversight aims to mitigate the risk of bias against enrollees based on the diagnosis made post-treatment.

Summary

House Bill 2035 focuses on the utilization review of emergency care claims under health benefit plans, aiming to protect patients seeking emergency medical assistance. By amending provisions in the Government Code and the Insurance Code, HB2035 ensures that health insurance providers adhere strictly to regulations regarding emergency care. The bill delineates that emergency care services provided must meet the prudent layperson standard, which ensures that the interpretation of the need for care is evaluated based on a general understanding of medical emergencies rather than solely on final diagnoses.

Contention

Key points of contention regarding HB2035 focus on the balance between cost containment in health insurance and the need for immediate and appropriate care. Some stakeholders argue that stringent review processes might disproportionately impact the operational frameworks of insurance providers potentially leading to increased costs. Conversely, advocates emphasize that protecting consumer rights in emergency health situations is paramount, suggesting that any increase in costs is justified in light of improved patient access and care quality.