The New Year rings in new protections for certain medical claims. Last year, Texas Governor Greg Abbott signed legislation to expand the existing law dealing with balance billing, which occurs when patients are directly billed by a provider for the portion of medical expenses not covered by their insurance.
This can happen when insured patients receive out-of-network care, often in an emergency care situation or when a patient is admitted to an in-network facility, but receives treatment from an out-of-network provider. Texas developed a mediation system back in 2009 to assist consumers in resolving certain balance bills and made improvements to the system in 2015, and most recently again in 2017.
The most recent legislation, which applies to claims incurred after Jan. 1, 2018, broadens the types of accounts that are eligible for mediation protections already used by insured consumers in Texas on a limited basis. The newest law expands access to mediation eligibility to all out-of-network providers treating patients at in-network hospitals and other facilities.
Before the latest revisions, the existing law made mediation available to consumers who were balance billed by only six types of facility-based providers: radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists and assistant surgeons. The law also provides for mediation of balance bills for emergency care from any provider or facility of emergency services care, including freestanding emergency rooms.
In an effort to bolster awareness of the mediation program, the new law also institutes a new disclosure requirement to inform consumers of their mediation rights. Healthcare providers and other facilities must include a statement substantially similar to the following: “You may be able to reduce some of your out-of-pocket costs for an out-of-network medical or health care claim that is eligible for mediation by contacting the Texas Department of Insurance at [website] and [phone number]” on bills that are eligible for mediation. The disclosure must be in at least 10-point boldface type.
Healthcare and emergency services providers should make sure they are familiar with the new balance billing requirements that apply to certain healthcare claims incurred on or after Jan. 1, 2018, and determine how they will impact current billing practices. Please note that the above-referenced legislation, S.B. 507, became law on Sept. 1, 2017, and applies to healthcare claims incurred after Jan. 1, 2018.