Texas House Bill HB3414

Texas 2025 - 89th Regular

• Filed: 2/26/25

Caption

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

Impact

If enacted, this bill would have significant implications for the way health insurance coverage is structured in Texas, particularly for those utilizing direct primary care services. By formally recognizing direct payments to physicians as qualified expenses under insurance policies, HB3414 could potentially lower overall healthcare costs for consumers and encourage more straightforward transactions between patients and providers. This approach may promote greater access to primary care and enhance transparency in billing practices, contributing to a more efficient healthcare delivery system.

Summary

House Bill 3414 aims to amend the Texas Insurance Code by introducing specific provisions for preferred provider benefit plans regarding out-of-pocket expense credits. Specifically, it seeks to ensure that payments made directly by an insured individual to a physician providing direct primary care are recognized as payments for medically necessary healthcare services. This change is intended to clarify the treatment of direct fees in the healthcare reimbursement landscape, emphasizing the importance of direct primary care relationships for insured individuals.

Contention

While the bill is geared towards supporting direct primary care, it may face scrutiny from insurance providers and regulatory bodies regarding its implementation. Concerns could arise around the increased financial liability for insurers, who may perceive this as expanding their responsibilities to cover more types of direct payments. Additionally, stakeholders in the healthcare industry may debate the best practices for ensuring that direct primary care remains a viable option for providers without compromising the quality or availability of broad healthcare services.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1301. Preferred Provider Benefit Plans
  • Section: 140