Relating to unfair claim settlement practices by an insurer that issues a preferred provider benefit plan.
Impact
The impact of HB1369 is significant as it modifies existing provisions under the Texas Insurance Code, ensuring that consumers who seek out-of-network services are charged fairly based on actual billed amounts rather than potentially inflated or arbitrary calculations by insurers. This is expected to promote transparency in how insurers calculate a policyholder's financial responsibility for out-of-network care, thereby protecting consumers from unexpected expenses and increasing accountability among insurance providers.
Summary
House Bill 1369 aims to address unfair claim settlement practices employed by insurers that issue preferred provider benefit plans in Texas. The bill specifically highlights that it is considered an unfair or deceptive act for these insurers to compute a policyholder's coinsurance for out-of-network services based on anything other than the billed charges from nonpreferred providers. This legislation seeks to ensure that consumers are not penalized with higher costs when they use out-of-network services that should be covered under their insurance plans.
Contention
There may be potential contention surrounding this bill, particularly regarding how insurers adjust their practices and premiums in response to the new regulation. Insurers may argue that the requirement to compute coinsurance based strictly on billed charges could lead to increased premiums for policyholders or a reduction in available providers within preferred networks, thus undermining the accessibility of affordable health care. The bill could provoke debate between consumer advocacy groups advocating for transparency and fairness and insurance companies concerned about regulatory burdens and cost implications.