Texas 2017 - 85th Regular

Texas House Bill HB1566

Filed
 
Out of Senate Committee
 
Voted on by Senate
 
Governor Action
 
Bill Becomes Law
 

Caption

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

Impact

The implications of HB 1566 on state laws are significant, particularly as they relate to the rights of consumers regarding health care costs. By enforcing mandatory mediation in specified circumstances, the bill directly influences how out-of-network claims are handled, establishing a more patient-friendly approach to resolving medical billing disputes. It encourages transparency and consumer awareness by requiring providers and insurers to inform enrollees about the mediation process before they incur charges.

Summary

House Bill 1566 addresses the mediation of health benefit claims linked to balance billing, particularly for out-of-network services. The bill introduces a structured mediation process aimed at resolving disputes between patients (enrollees) and providers when the amount a patient owes exceeds $500. The legislation mandates that enrollees may seek mediation in cases involving significant out-of-network medical bills, specifically for emergency care or when services are rendered by facility-based providers who are not in-network. This legislative change seeks to protect consumers from unexpected medical expenses while giving them a mechanism for recourse when disputes arise over billing.

Sentiment

The general sentiment surrounding HB 1566 appears to be in favor of consumer protection and fairness in healthcare billing. Advocates argue that the bill empowers patients, alleviating fears of substantial out-of-pocket expenses when receiving emergency or unforeseen medical care. However, there are concerns regarding how the mediation process could potentially affect care delivery or insurance premiums, reflecting a degree of wariness from some stakeholders in the health insurance industry.

Contention

Notable points of contention include the operational implications for both health care providers and insurers who must adapt to the new mediation requirements. Some stakeholders express apprehension that these changes could lead to increased overall health care costs or a shift in how facilities price their services. The requirement for mediation, while beneficial in theory, also raises questions about its feasibility and execution in real-world scenarios, particularly around the burden it may impose on healthcare providers while attempting to balance patient care and billing practices.

Companion Bills

TX SB507

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

Previously Filed As

TX SB2476

Relating to consumer protections against certain medical and health care billing by emergency medical services providers.

TX HB3773

Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.

TX HB4500

Relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.

TX SB863

Relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.

TX HB1364

Relating to a direct payment to a health care provider in lieu of a claim for benefits under a health benefit plan.

TX SB583

Relating to a direct payment to a health care provider in lieu of a claim for benefits under a health benefit plan.

TX HB5186

Relating to the establishment of the state health benefit plan reimbursement review board and the reimbursement for health care services or supplies provided under certain state-funded health benefit plans.

TX SB1723

Relating to the backdating of referrals for certain managed care health benefit plans.

TX SB622

Relating to the disclosure of certain prescription drug information by a health benefit plan.

TX HB1754

Relating to the disclosure of certain prescription drug information by a health benefit plan.

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