Texas Senate Bill SB1615

Texas 2017 - 85th Regular

Caption

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.

Impact

If enacted, SB1615 would significantly impact how balance billing is managed and regulated in Texas. Specifically, it introduces new provisions that ensure enrollees are informed about potential costs when using out-of-network services. By establishing a framework for mediation in cases where patients are charged more than $500 due to balance billing, the bill aims to provide a mechanism for resolving disputes between healthcare providers and enrollees, ultimately seeking to reduce the financial surprise that patients often face in such situations.

Summary

Senate Bill 1615 addresses the issue of balance billing in health benefit plans within Texas. The bill specifically aims to clarify what constitutes balance billing when a patient receives services from an out-of-network provider. It defines balance billing as the practice where a healthcare provider attempts to recover the difference between the amount charged and what is reimbursed by the insurance plan from the patient. The bill seeks to establish requirements for disclosures and mediation processes to protect patients from unexpected out-of-pocket expenses when they are treated by out-of-network providers.

Contention

Despite its protective intentions, the bill could face opposition stemming from concerns regarding the implications for healthcare providers. Opponents may argue that the regulations could potentially limit the ability of healthcare providers to negotiate for fair compensation for their services. Additionally, there may be concerns regarding the practicality and effectiveness of the mediation process laid out in the bill, leading to discussions on whether it adequately addresses the needs of all stakeholders involved in the healthcare delivery system.