Relating to payment standards for preferred provider benefit plans to reduce balance billing of insureds for out-of-network health care services.
Should HB3755 be enacted, it will alter the financial landscape for patients dealing with unexpected balance bills. Patients may see a reduction in occurrences where they are charged excessive amounts for out-of-network services, which has been a significant concern for insured individuals. By aligning payment standards with the average billed amounts by preferred providers in a designated area, this legislation aims to foster fairness and transparency in healthcare billing practices.
House Bill 3755 aims to establish clearer payment standards for preferred provider benefit plans in Texas to significantly reduce instances of balance billing for out-of-network healthcare services. The bill mandates that if an out-of-network provider submits a claim for a covered service, insurance companies must reimburse the provider at least the average amount billed by preferred providers in the relevant geozip area, minus any patient responsibility under their plan. This bill is designed to protect insured individuals from unexpected and potentially exorbitant out-of-pocket expenses when receiving care outside their network.
Some concerns have been raised about how this bill may influence the relationships between insurance companies and healthcare providers, particularly regarding the reimbursement rates for out-of-network services. Stakeholders in the healthcare sector may argue that the mandated minimum payment could lead to increased costs for insurers or limit the willingness of out-of-network providers to accept such payments. Furthermore, there may be contention regarding the definition of 'geozip area' and how this could impact pricing discrepancies in rural versus urban settings.
The law specifies that HB3755 applies only to preferred provider benefit plans delivered, issued, or renewed on or after January 1, 2018, signaling that previous arrangements made under earlier regulations will continue unaffected. The bill is poised to take effect on September 1, 2017, potentially changing the reimbursement landscape for all stakeholders involved in healthcare financing in Texas.