Texas Senate Bill SB177

Texas 2025 - 89th Regular

• Filed: 11/12/24

Caption

Relating to telephone access for certain health benefit plan verifications and preauthorization requests and for utilization review requests.

Impact

If enacted, SB177 would have significant implications for how health benefit plans operate regarding patient care management. By ensuring round-the-clock availability for responding to verification and preauthorization requests, the bill seeks to streamline processes that often delay necessary medical services. This amendment is particularly relevant for patients requiring immediate treatment or procedures that are contingent upon timely authorizations from their insurance providers.

Summary

Senate Bill 177 proposes amendments to the Texas Insurance Code to improve telephone access for health benefit plan verifications and preauthorization requests. The bill mandates that health maintenance organizations (HMOs) and insurers maintain personnel availability via toll-free telephone numbers 24 hours a day, seven days a week, including legal holidays. This change aims to enhance the responsiveness of HMOs to verification and preauthorization inquiries, which are critical for timely healthcare access and service utilization.

Contention

While the intent of SB177 is to improve accessibility and efficiency in health administration, there may be concerns regarding the operational feasibility for smaller healthcare providers and insurers. Proponents argue that the bill will not only serve patients better but also encourage transparency in the health verification process. Conversely, some stakeholders might worry that the operational burden placed on insurance providers could lead to increased costs, potentially impacting insurance premiums and overall healthcare costs in Texas.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 843. Health Maintenance Organizations
  • Section: 347
  • Section: 348

• Chapter 1301. Preferred Provider Benefit Plans
  • Section: 133
  • Section: 135

• Chapter 4201. Utilization Review Agents
  • Section: 004