TX
Texas House Bill HB174

Texas 2021 - 87th 3rd C.S.

Texas House Bill HB174

Caption

Relating to preferred provider benefit plan reimbursement of certain services provided by out-of-network providers.

Impact

The changes proposed by HB 174 are expected to have significant implications for both out-of-network providers and the health insurance landscape in Texas. By ensuring that out-of-network providers can receive payments based on their specialty and historical rates, the bill aims to incentivize these providers to deliver necessary services, especially in emergency situations where timely care is crucial. This could lead to improved patient outcomes by reducing the financial burden on providers, thereby encouraging more of them to offer emergency and specialized services.

Summary

House Bill 174 proposes amendments to the Texas Insurance Code that relate to the reimbursement of services provided by out-of-network healthcare providers. The main focus of the bill is to ensure that physicians and healthcare providers who are not part of a preferred provider network receive fair compensation for certain services. Specifically, the bill stipulates that when a non-preferred provider delivers emergency care or specialty services that are unavailable from preferred providers, they will be reimbursed based on their specialty rates rather than the insurer's usual and customary rates.

Contention

While the bill promotes fair reimbursement for out-of-network providers, it may also lead to disputes between insurers and healthcare providers regarding the definition of specialty rates and the circumstances under which they apply. Insurers might be concerned about the potential for increased costs due to higher reimbursement rates for out-of-network services, which could ultimately affect policyholder premiums. Additionally, discussions surrounding the bill may reflect broader tensions between maintaining a robust network of providers and the financial sustainability of health insurance plans.

Companion Bills

No companion bills found.

Previously Filed As

TX HB3359

Relating to network adequacy standards and other requirements for preferred provider benefit plans.

TX SB1765

Relating to network adequacy standards and other requirements for preferred provider benefit plans.

TX HB3195

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

TX HB3848

Relating to health maintenance organization and preferred provider benefit plan minimum access standards for nonemergency ambulance transport services delivered by emergency medical services providers; providing administrative penalties.

TX HB3773

Relating to claims submitted and requests for verification made by a physician or health care provider to certain health benefit plan issuers and administrators.

TX HB3985

Relating to an insurer's obligation under a preferred provider benefit plan for continuity of care for certain Medicaid recipients.

TX SB1666

Relating to an insurer's obligation under a preferred provider benefit plan for continuity of care for certain Medicaid recipients.

TX HB5186

Relating to the establishment of the state health benefit plan reimbursement review board and the reimbursement for health care services or supplies provided under certain state-funded health benefit plans.

TX HB4500

Relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.

TX HB2002

Relating to preferred provider benefit plan out-of-pocket expense credits for payments made by an insured directly to a physician or health care provider.

Similar Bills

No similar bills found.