85R9205 SMT-F
By: Campbell S.B. No. 1615
A BILL TO BE ENTITLED
AN ACT
relating to what constitutes balance billing of a health benefit
plan enrollee by a physician or health care provider for purposes of
certain disclosure and medication requirements.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1456.001(1), Insurance Code, is amended
to read as follows:
(1) "Balance billing" means the practice of charging
an enrollee in a health benefit plan that uses a provider network to
recover from the enrollee the balance of a non-network health care
provider's fee for service received by the enrollee from the health
care provider that is not fully reimbursed by the enrollee's health
benefit plan. The term does not include charging for:
(A) any deductible, copayment, or coinsurance
amount for which the enrollee is obligated under the health benefit
plan; or
(B) any amount the health benefit plan is
obligated to reimburse the enrollee or to pay on behalf of the
enrollee for service received by the enrollee from the health care
provider.
SECTION 2. Section 1467.051(a), Insurance Code, is amended
to read as follows:
(a) An enrollee may request mediation of a settlement of an
out-of-network health benefit claim if:
(1) the amount charged to the enrollee through balance
billing as defined by Section 1456.001 [amount for which the
enrollee is responsible to a facility-based physician, after
copayments, deductibles, and coinsurance, including the amount
unpaid by the administrator or insurer,] is greater than $500; and
(2) the health benefit claim is for a medical service
or supply provided by a facility-based physician in a hospital that
is a preferred provider or that has a contract with the
administrator.
SECTION 3. This Act takes effect September 1, 2017.