Texas 2015 - 84th Regular

Texas House Bill HB3133 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R2307 LED-F
2	2	By: Smithee H.B. No. 3133
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to notice and availability of mediation for balance
8	8	billing by a facility-based physician.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 324.001(8), Health and Safety Code, is
11	11	amended to read as follows:
12	12	(8) "Facility-based physician" means a radiologist,
13	13	an anesthesiologist, a pathologist, an emergency department
14	14	physician, [or] a neonatologist, or an assistant surgeon.
15	15	SECTION 2. Section 1456.001(3), Insurance Code, is amended
16	16	to read as follows:
17	17	(3) "Facility-based physician" means a radiologist,
18	18	an anesthesiologist, a pathologist, an emergency department
19	19	physician, [or] a neonatologist, or an assistant surgeon:
20	20	(A) to whom the facility has granted clinical
21	21	privileges; and
22	22	(B) who provides services to patients of the
23	23	facility under those clinical privileges.
24	24	SECTION 3. Section 1456.004(c), Insurance Code, is amended
25	25	to read as follows:
26	26	(c) A facility-based physician who bills a patient covered
27	27	by a preferred provider benefit plan or a health benefit plan under
28	28	Chapter 1551 that does not have a contract with the facility-based
29	29	physician shall send a billing statement to the patient that
30	30	contains a conspicuous, plain-language explanation [with
31	31	information sufficient to notify the patient] of the mandatory
32	32	mediation process available under Chapter 1467 if [the amount for
33	33	which] the enrollee is responsible to the physician, after
34	34	copayments, deductibles, and coinsurance, for an [including the]
35	35	amount unpaid by the administrator or insurer [, is greater than
36	36	$1,000].
37	37	SECTION 4. Section 1467.001(4), Insurance Code, is amended
38	38	to read as follows:
39	39	(4) "Facility-based physician" means a radiologist,
40	40	an anesthesiologist, a pathologist, an emergency department
41	41	physician, [or] a neonatologist, or an assistant surgeon:
42	42	(A) to whom the facility has granted clinical
43	43	privileges; and
44	44	(B) who provides services to patients of the
45	45	facility under those clinical privileges.
46	46	SECTION 5. Section 1467.051(a), Insurance Code, is amended
47	47	to read as follows:
48	48	(a) An enrollee may request mediation of a settlement of an
49	49	out-of-network health benefit claim if:
50	50	(1) [the amount for which] the enrollee is responsible
51	51	to a facility-based physician, after copayments, deductibles, and
52	52	coinsurance, for an [including the] amount unpaid by the
53	53	administrator or insurer[, is greater than $1,000]; and
54	54	(2) the health benefit claim is for a medical service
55	55	or supply provided by a facility-based physician in a hospital that
56	56	is a preferred provider or that has a contract with the
57	57	administrator.
58	58	SECTION 6. Sections 1456.004(c) and 1467.051(a), Insurance
59	59	Code, as amended by this Act, apply only to charges for a medical
60	60	service or supply provided on or after the effective date of this
61	61	Act. Charges for a medical service or supply provided before the
62	62	effective date of this Act are governed by the law as it existed
63	63	immediately before the effective date of this Act, and that law is
64	64	continued in effect for that purpose.
65	65	SECTION 7. This Act takes effect September 1, 2015.