Texas House Bill HB2967

Texas 2019 - 86th Regular

Caption

Relating to prohibited balance billing and an independent dispute resolution program for out-of-network coverage under certain managed care plans; authorizing a fee.

Impact

The legislation is expected to significantly alter the landscape of healthcare billing in Texas by enforcing a framework where out-of-network providers cannot charge enrollees beyond the amounts specified by their managed care arrangements. By mandating that health benefit plan issuers cover the usual, customary, and reasonable rates for services, this bill is designed to lower the financial risks for patients and prevent instances of surprise billing, which can occur in emergency situations or when a patient receives unintended out-of-network care.

Summary

House Bill 2967 introduces provisions regarding prohibited balance billing and establishes an independent dispute resolution program for out-of-network healthcare services covered under certain managed care plans. The bill aims to protect enrollees by ensuring that they are not financially responsible for amounts exceeding their agreed liability under managed care plans, thereby alleviating the burden of unexpected medical bills when out-of-network services are utilized. This legislation seeks to promote a more equitable healthcare payment system and improve transparency in billing practices.

Contention

As with many healthcare reforms, there are points of contention surrounding HB 2967. While proponents argue that the bill will enhance consumer protections and promote fair billing practices, opponents may express concerns about the financial implications for out-of-network providers and the insurance companies. Critics might argue that the regulations could limit provider reimbursement rates and potentially create a disincentive for out-of-network providers to participate in the market. The effectiveness and efficiency of the independent dispute resolution process will also be scrutinized, as it may raise questions regarding its ability to resolve conflicts swiftly and fairly.