Texas Senate Bill SB1591

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 implementation of SB1591 would significantly influence state laws relating to healthcare insurance practices by mandating clearer guidelines for dispute resolution between enrollees, out-of-network providers, and health plan issuers. The establishment of a mediation process would facilitate communication among these parties, ultimately aiming to reduce the financial ambiguity and stress faced by patients receiving emergency care or services from providers outside their insurance network.

Summary

SB1591 aims to address the issue of balance billing by introducing an independent dispute resolution program for out-of-network providers under certain managed care plans in Texas. The legislation seeks to prohibit out-of-network providers from charging enrollees more than their managed care plan's designated amounts, thus protecting patients from surprise medical bills in emergencies or when they unknowingly use out-of-network services. The bill necessitates that health benefit plan issuers compensate out-of-network providers at 'usual, customary, and reasonable rates' or at rates agreed upon in their contracts.

Contention

While proponents argue that SB1591 enhances consumer protection and transparent billing practices, concerns have been raised regarding the bill’s impact on healthcare providers. Critics suggest that out-of-network providers may find it challenging to negotiate equitable compensation due to the imposed limits. Furthermore, there is some apprehension that the measures could discourage certain providers from participating in managed care networks, potentially leading to less access to services for insured patients.