TAFEC Passes Resolution to Increase Health Insurance Data Collection

Managed Care Weekly Digest

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- The Texas Association of Freestanding Emergency Centers (HYPERLINK "http://tafec.org/" nTAFEC) has called on the Texas Legislature and the Texas Department of Insurance (TDI) to increase the collection of health insurance payment data to establish clear standards for the usual and customary reimbursements that insurance companies are required by law to pay healthcare providers on behalf of policyholders (see also Texas Association of Freestanding Emergency Centers).

Currently, Texas law requires insurance providers to pay for non-contracted emergency health care at the usual and customary rate for emergency care. However, there are no uniform guidelines for insurance companies to follow, which allows insurers to determine their own arbitrary rates. While some insurers provide adequate payment for services, others are paying at a percentage below what is legally required, which means patients do not receive the full benefit of the coverage they purchased.

Creating an enforceable standard for usual and customary rates is necessary to hold health plans accountable, ensure healthcare providers are paid sufficiently for their services, and most importantly, reduce out-of-pocket costs for consumers.

In its resolution, TAFEC requests that the TDI perform and publish the results of surveys of insurers to obtain the data needed for patients and providers to have certainty regarding what constitutes usual and customary reimbursement for all reimbursement codes for emergency room procedures and treatment events across all regions of the state.

Furthermore, TAFEC requests that the Texas Legislature ensure that TDI has the directive, authority, and resources to gather, update, maintain, and publish the data controlled by insurers that are necessary to provide the public and healthcare providers with a reliable and comprehensive source of healthcare reimbursement information. This information will be necessary to properly enforce the usual and customary healthcare reimbursement requirement of current law.

Brad Shields, executive director of TAFEC, stated, "Once clear standards for usual and customary reimbursement are established and appropriately enforced, incidents of surprise billing and confusion surrounding medical billing will be significantly reduced. Collecting this data is critical to ensure consistent reimbursement rates from insurance companies to emergency care providers on behalf of patients."

This resolution is part of a larger effort to increase transparency and oversight in health insurance. Once this data is collected, it will be evident which insurance companies are providing fair reimbursement and which companies are not. The goal is to change insurer behavior in order to protect Texas consumers from increased out-of-pocket expenses.

To review the full resolution, click HYPERLINK "http://tafec.org/advocacy/tdi-oversight/" nhere.

Keywords for this news article include: Legal Issues, Health Insurance, Texas Association of Freestanding Emergency Centers.