Texas Legislators File Bills to Increase Health Insurance Transparency, Oversight

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- The Texas Association of Freestanding Emergency Centers (HYPERLINK "http://tafec.org/" nTAFEC) supports legislation introduced in the Texas Legislature aimed at increasing oversight of health insurance companies and protecting consumers from surprise medical costs (see also Texas Association of Freestanding Emergency Centers).

The bills, many of which have bi-partisan support, seek to increase transparency in the health insurance industry, ensure the Texas Department of Insurance has the resources to enforce current statutes regulating health insurance companies, and allow healthcare providers to advocate on behalf of their patients for fair payment.

Increased Health Insurance Transparency

A recent HYPERLINK "http://newsroom.acep.org/2017-03-16-Public-Overwhelmingly-Wants-Insurance-Companies-To-Cover-Emergency-Care-and-To-Be-Transparent" npoll conducted by the American College of Emergency Physicians found that nine in 10 registered voters want to know how insurers calculate coverage for emergency care. Rep. Greg Bonnen recently filed HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB02077I.htm" nHB 2077, which would require health insurance companies to report biannually to the Texas Department of Insurance explaining calculation of payment rates for out-of-network physicians and facilities.

Data collection is critical in determining a usual and customary standard, establishing consistency among health insurance companies, and penalizing bad actors that intentionally underpay providers. Once the data has been submitted to the Texas Department of Insurance, HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB03348I.htm" nHB 3348 by Rep. Dennis Paul would enable the insurance commissioner to develop a standard for fair payment among insurers.

To further improve transparency, Sen. Donna Campbell has filed HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB01614I.htm" nSB 1614, which would address misleading language or misrepresentations included in an explanation of benefits provided by a health insurance company.

Expanding Oversight and Enforcement of Insurance Regulations

The current healthcare landscape in Texas allows health insurance companies to operate with limited oversight or enforcement of existing regulations.

To ensure health plans are discouraged from underpaying providers, Rep. Sergio Munoz Jr. has filed HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB02620I.htm" nHB 2620, which would award damages and court costs to the plaintiff in disputes regarding prohibited acts or practices by insurers.

TAFEC also supports HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB02942I.htm" nHB 2942 filed by Rep. Munoz Jr., HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB02945I.htm" nHB 2945 by Rep. Munoz Jr., HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB01485I.htm" nSB 1485 by Sen. Donna Campbell, HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB03755I.htm" nHB 3755 by Rep. Rodney Anderson, and HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB01486I.htm" nSB 1486 by Sen. Donna Campbell. These bills promote adequate networks and create a standard for fair reimbursement in order to reduce the instances of surprise bills.

Advocating on Behalf of Patients

Rep. Munoz Jr. also filed HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/HB02449I.htm" nHB 2449 relating to the assignment of health insurance benefits to a physician or health care provider. This bill would enable freestanding emergency centers and other providers to initiate dispute resolution with the Texas Department of Insurance on behalf of their patients when it is evident a health plan has not met the legal requirement to pay at the usual and customary rate.

Sen. Campbell also filed companion legislation in the Senate (HYPERLINK "http://www.legis.state.tx.us/tlodocs/85R/billtext/html/SB01613I.htm" nSB 1613). The intent of these bills is to change insurance payment behavior and prevent chronic underpayment by insurance companies, which leads to large surprise bills for patients.

TAFEC commends these legislators for their work to increase insurance oversight and demand much needed transparency within the health insurance industry. Download our HYPERLINK "http://tafec.org/wp-content/uploads/Payment-Game-.pdf" nwhite paper for more information about health insurance transparency and oversight.

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

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