Texas House Bill HB3484

Texas 2019 - 86th Regular

Caption

Relating to conduct of insurers providing preferred provider benefit plans with respect to physician and health care provider contracts and claims.

Impact

If enacted, HB3484 may significantly alter the landscape of healthcare insurance in Texas by amending the Insurance Code to prohibit retaliatory measures against providers, encouraging more thorough and fair claim processes. The bill stipulates that insurers must adhere to timelines for processing clean claims, ensuring a more predictable and reliable reimbursement process for healthcare providers. Furthermore, it introduces a formal mechanism for appealing insurer decisions post-audit, promoting greater transparency and accountability within insurance operations.

Summary

House Bill 3484 focuses on the conduct of insurers providing preferred provider benefit plans in regards to contracts and claims with healthcare providers. The bill aims to protect physicians and healthcare providers from retaliatory actions taken by insurers when these providers file complaints or appeal decisions regarding claims. This legislative change seeks to ensure that healthcare providers can operate without the fear of losing their contracts or facing penalties for advocating for their patients' rights. The bill establishes clearer guidelines for allowable actions by insurers and sets protocols that uphold the rights of providers.

Contention

Discussions surrounding HB3484 highlight some contention regarding the balance of power between insurers and healthcare providers. Supporters argue that the protections against retaliation will empower providers and improve patient care, while critics might express concerns about potential repercussions for insurers, such as increased operational costs or reduced flexibility in managing provider agreements. The bill reflects an ongoing debate about the regulation of healthcare insurance practices and the equitable treatment of healthcare providers.