Texas Senate Bill SB1562

Texas 2015 - 84th Regular

Caption

Relating to nonpreferred provider claims under a preferred provider benefit plan related to emergency care.

Impact

The passage of SB1562 is expected to change the way emergency care claims are handled within the state. Insurers will now be required to pay a reasonable amount to nonpreferred providers for emergency care services. The bill also protects insured individuals from excessive costs by ensuring they are not billed beyond typical copayments or deductibles associated with their preferred provider plans. This holds significant implications for insurance practices, as it may also encourage insurers to negotiate fairer rates with healthcare providers.

Summary

Senate Bill 1562 aims to address issues concerning claims made by nonpreferred providers under preferred provider benefit plans, specifically relating to emergency care. This bill establishes a subchapter within the Insurance Code that outlines the process for resolving disputes between insurers and nonpreferred providers over payment amounts for emergency care services. Through this legislation, it is anticipated that patients will not be responsible for excessive costs that could arise from nonpreferred providers billing outside of their insurance coverage during emergencies.

Contention

Despite the expected benefits of SB1562, the bill has faced scrutiny. Concerns have been raised regarding the balance of power between nonpreferred providers and insurers. Some argue that establishing arbitration without careful oversight could lead to inequities, where nonpreferred providers might face challenges in receiving fair compensation for their services. Additionally, the effectiveness of the arbitration process and its accessibility to all parties involved, particularly patients, is a notable point of contention. Legislators will need to consider these factors as they deliberate on the bill's final provisions.