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TX physicians take note: New law may impact health care billing

The Texas Legislature has recently proposed a new rule that will limit health billing options. Lawmakers state the new law, scheduled to go into effect January 1, will help protect patients from surprise medical bills. But medical professionals have voiced concern the law may have unintended, negative consequences for patients.

What is the goal of this law?

Lawmakers have stated they intend Senate Bill 1264 to provide protection against surprise, out-of-network bills. If such a surprise were to occur, under this new law patients would arbitrate a fair bill with insurers and providers. However, such billing limitations could have unforeseen consequences for patients.

One example: what if a patient wants to seek care from an out-of-network physician for a scheduled procedure? What if a surgeon prefers to work with a particular anesthesiologist, but that professional is out-of-network? As written, the law may make it difficult for the health care professional to bill the patient.

Is there a solution to this potential problem?

To ease this process, the Texas Medical Board (TMB) has proposed a rule that would allow health care providers to send bills to patients who receive non-emergency care. This would include scheduled surgical procedures.

The rule achieves this goal by making the most of an exception that is already a part of the law. SB 1264 already allows patients to knowingly receive out-of-network, nonemergency care in specific situations if the patient signs a waiver. The TMB’s proposal extends this exception to cover a greater number of situations, such as those noted above.

The proposed rules are still under discussion and it is unclear if they will go through. We will provide updates as they become available.

Is there a broader lesson here?

Physicians must do more than just provide quality care for patients. They must navigate the laws that impact their practice. Those who find themselves accused of violating these laws are wise to seek legal counsel to better ensure their interests are protected.

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