Texas Surprise Billing Legislation Closer to Becoming Law

May 22, 2019

The bill that seeks to save Texans millions of dollars, passed through the Senate on Tuesday; the vote was 29-2.

We have been tracking the surprise billing legislation making its way through the Texas Legislature throughout the 2019 session. Senate Bill 1264 attempts to address surprise medical billing, and is an extension of legislation introduced a decade ago.

The goal of the bill is to provide relief to individuals who have recently received surprise medical bills that occur when an insurance companies and healthcare providers fail to reach a consensus on the cost of a medical service. These medical bills, commonly known as balance bills, typically come as a surprise to patients, because they do not realize that they have received treatment at an out-of-network provider.

You can read more details about the bill here, and take a look at the bill text itself here.

Under current law, patients have to formally request a mediation process through the Texas Department of Insurance. Insurance companies and healthcare providers have 30 days from the date of mediation request to host an informal telephone call in an attempt to resolve the issue. If no resolution is reached the case is referred to the State Office of Administrative Hearings for further action.

This process has resulted in backlog, and was the catalyst for Senate Bill 1264.  

“Ideally, all Texans should have a way to resolve a surprise medical bill, and this bill moves Texas in that direction,” said Sen. Hancock while explaining the bill.

The two votes in opposition come from Republican Senators, both of whom are physicians. Sen. Campbell inquired of the Texas Department of Insurance (TDI) during public testimony:

“Have you seen any numbers that show what it [the bill] does for physicians trying to be paid for their services?”

And, Sen. Schwertner questioned whether insurance companies are held to the same standards as healthcare providers:

“Would you have the authority to regulate other parameters of that insurance product such as network adequacy and provision of provider directories?

The bill continues to evolve through the legislature. You can watch the public testimony of the bill, here.