Texas House Bill HB1929

Texas 2009 - 81st Regular

Caption

Relating to payment of claims of certain out-of-network physicians and health care providers.

Impact

The implications of HB1929 are significant for the state's healthcare landscape. By ensuring that out-of-network providers can be reimbursed at in-network rates under specific conditions, the bill aims to alleviate some of the financial burden on patients who need emergency services or specialized care that is not readily available within their insurance network. This could lead to an increase in patient satisfaction and trust in managed care systems, as patients may feel more secure in seeking necessary care without the fear of exorbitant out-of-pocket costs.

Summary

House Bill 1929 focuses on the payment of claims for certain out-of-network physicians and health care providers. The bill introduces a new section to the Insurance Code that stipulates conditions under which managed care plans must reimburse out-of-network providers. Specifically, it requires that these providers be paid at the same rates as participating providers, provided the enrollee has made a reasonable effort to seek care from an in-network provider but was unsuccessful. This change aims to enhance the financial protection of patients when they cannot access covered services through their managed care plan.

Contention

While proponents argue that HB1929 offers a much-needed safety net for patients in urgent situations, there may be concerns from insurance companies regarding the potential rise in costs associated with higher reimbursement rates for out-of-network services. Critics may also point to the challenge of defining what constitutes a 'reasonable effort' to find a participating provider, as this could vary widely among patients. Such ambiguity raises questions about the implementation and enforcement of these provisions and may lead to disputes between insurers and healthcare providers.