Texas Senate Bill SB1486

Texas 2017 - 85th Regular

Caption

Relating to payment standards for preferred provider benefit plans to reduce balance billing of insureds for out-of-network health care services.

Impact

The implications of SB1486 on state laws include a modification of the Insurance Code to enhance consumer protections against balance billing practices. By ensuring that out-of-network providers receive payment that reflects a fair rate based on local provider standards, it aims to alleviate some of the financial burdens currently faced by insured individuals when they inadvertently receive care from providers outside their network. This change also intends to foster a more predictable healthcare cost framework, potentially leading to increased transparency in medical billing.

Summary

SB1486 aims to establish payment standards for preferred provider benefit plans that address the issue of balance billing for out-of-network healthcare services. Specifically, the bill prohibits insurers from making payments to out-of-network providers that are less than the average amount billed for similar services by preferred providers in the applicable geozip area. This measure seeks to provide better financial protections for insured individuals who receive services from out-of-network providers, thereby reducing unexpected medical bills.

Contention

Discussions surrounding SB1486 may involve debates over the balance between protected patient rights and the financial stability of healthcare providers. Stakeholders may express concerns regarding how such payment restrictions could impact the willingness of out-of-network providers to treat patients and the overall accessibility of services. Proponents argue that the bill is essential for consumer protection, while opponents may highlight possible unintended consequences, particularly regarding the availability and quality of out-of-network healthcare services.