Tennessee House Bill HB1213

Tennessee 2023-2024 Regular Session

• Introduced: 1/31/23
• Refer: 2/2/23
• Refer: 2/21/23
• Refer: 2/28/23
• Engrossed: 3/7/23
• Enrolled: 3/31/23
• Passed: 4/25/23
• Chaptered: 5/3/23

Caption

AN ACT to amend Tennessee Code Annotated, Title 8; Title 56 and Title 71, relative to insurance.

Impact

If enacted, HB 1213 will significantly impact insured individuals' financial responsibilities in Tennessee. By enabling consumers to count out-of-pocket expenses from out-of-network services towards their deductible, it seeks to relieve some of the financial burdens associated with healthcare costs when patients choose services outside their insurance network. This adjustment aims to encourage cost-effective healthcare choices while enhancing transparency in out-of-network costs for consumers.

Summary

House Bill 1213 aims to amend Tennessee Code Annotated regarding insurance regulations, specifically focusing on how out-of-pocket payments for healthcare services from out-of-network providers are treated. It introduces a framework that allows an enrollee who pays for a healthcare service out-of-pocket to submit documentation to their insurance carrier to ensure that the full amount they paid is counted towards their deductible, coinsurance, or cost-sharing amount. This is applicable only if the enrollee has negotiated a lower price than what the insurance carrier typically pays for similar services within their network.

Sentiment

The sentiment around HB 1213 appears to be generally supportive among policymakers focused on improving healthcare affordability and consumer rights. Proponents argue that the bill provides much-needed clarity and support for individuals in navigating their healthcare expenses, especially in complex situations involving out-of-network care. However, concerns have also been raised about the implications for insurance providers and the overall insurance market dynamics, suggesting a nuanced debate that recognizes both benefits and potential challenges.

Contention

Notable points of contention surrounding HB 1213 include potential pushback from insurance companies, which may be concerned about the financial implications of having to recognize out-of-network expenses more broadly. Additionally, legislators may debate the adequacy of safeguards to prevent misuse of the provisions intended to benefit consumers. Balancing incentives for cost-effective care while ensuring that insurance companies remain viable and able to offer competitive policies remains a sensitive aspect of the discussions about this bill.