Relating to prompt payment of certain physicians and health care providers by a preferred provider benefit plan.
Impact
If enacted, HB 1691 would modify the existing Insurance Code, specifically Section 1301.069, to streamline the reimbursement protocols for certain healthcare services. The bill stipulates that claims submitted for payment on or after January 1, 2016, will fall under the new provisions set forth in this legislation, thereby potentially affecting the operational procedures of insurers and the financial stability of out-of-network providers who are entitled to timely payments.
Summary
House Bill 1691 focuses on the prompt payment of physicians and healthcare providers by preferred provider benefit plans. The bill aims to address the payment processes for healthcare services, particularly for services provided by physicians who are not part of the preferred provider network. It emphasizes the need for timely payments to healthcare providers and clarifies the criteria for such payments, especially in emergency care situations or when care is requested for specialty services due to the unavailability of preferred providers.
Contention
While the bill's intention to ensure prompt payment for healthcare services is generally seen as positive, it may lead to discussions about the implications for insurance companies and their payment structures. Stakeholders may debate the adequacy of the proposed measures in truly improving payment times and how the changes might affect healthcare costs and access in Texas. Additionally, there could be concerns from insurance representatives regarding the potential financial impact on their operations as they adapt to the updated requirements.
Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.
Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician or health care provider.