83R12243 AJA-F
By: Smithee H.B. No. 2838
A BILL TO BE ENTITLED
AN ACT
relating to the disclosure by health care practitioners and
facilities of the price of certain health care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 1456, Insurance Code, is
amended to read as follows:
CHAPTER 1456. DISCLOSURE OF PROVIDER STATUS AND PRICE
SECTION 2. Section 1456.003(a), Insurance Code, is amended
to read as follows:
(a) Each health benefit plan that provides health care
through a provider network shall provide notice to its enrollees
that:
(1) a facility-based physician or other health care
practitioner may not be included in the health benefit plan's
provider network; and
(2) subject to Section 1456.008, a health care
practitioner described by Subdivision (1) may balance bill the
enrollee for amounts not paid by the health benefit plan.
SECTION 3. Section 1456.007, Insurance Code, is amended to
read as follows:
Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES. A
health benefit plan that must comply with this chapter under
Section 1456.002 shall, on the request of an enrollee, provide an
estimate of payments that will be made for any health care service
or supply and shall also specify any deductibles, copayments,
coinsurance, or other amounts for which the enrollee is
responsible. The estimate must be provided not later than the 10th
business day after the date on which the estimate was requested. A
health benefit plan must advise the enrollee that:
(1) the actual payment and charges for the services or
supplies will vary based upon the enrollee's actual medical
condition and other factors associated with performance of medical
services; and
(2) subject to Section 1456.008, the enrollee may be
personally liable for the payment of services or supplies based
upon the enrollee's health benefit plan coverage.
SECTION 4. Chapter 1456, Insurance Code, is amended by
adding Section 1456.008 to read as follows:
Sec. 1456.008. PRICE DISCLOSURE BY HEALTH CARE
PRACTITIONERS AND FACILITIES. (a) At least 48 hours before
providing a health care service other than emergency care, as
defined by Section 1301.155, to a patient covered by a health
benefit plan described by Section 1456.002, a health care
practitioner or facility must disclose to the patient the price
that will be accepted as payment in full for the service. The
disclosure required by this section must be provided in writing in a
readily understandable manner.
(b) Notwithstanding another provision of this chapter or
any other law, a health care practitioner or facility that does not
make a disclosure required by this section before providing a
health care service may not:
(1) attempt to collect from the patient, by lawsuit or
otherwise, any billed amount that would otherwise be owed by the
patient for the service; or
(2) furnish adverse information to a consumer
reporting agency regarding any billed amount that would otherwise
be owed by the patient for the service.
(c) In addition to any other remedy provided by this chapter
or other law, a health care practitioner or facility shall hold a
patient harmless from any damages resulting from the practitioner's
or facility's violation of this section.
SECTION 5. The change in law made by this Act applies only
to a service provided to an enrollee by a health care practitioner
or facility on or after January 1, 2014. A service provided to an
enrollee by a health care practitioner or facility before January
1, 2014, is governed by the law in effect immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 6. This Act takes effect September 1, 2013.