Private practices in Texas must navigate federal, state and local health care regulations. They must stay current and make sure their businesses are in line with any changes to the law. As a result, private practices throughout the state are likely reviewing their billing practices to make sure they are in line with a newly passed law designed by lawmakers to limit surprise billing.
Three things health care providers should consider when reviewing their practices include:
- Coverage. The law is specifically aimed to protect those who use private health insurance and state regulated plans. As such, it generally applies to patients who work as state employees, public school teachers and those who receive coverage through their private employers. It is likely the law will apply to approximately one-third of all Texans.
- Emergency versus non-emergent care. The law states that it may not apply patients who intentionally seek medical care from out-of-network providers.
- Focus on balance bills. According to a recent piece in the Texas Tribune, the law focuses on balance bills, to portion not covered by insurance. This type of bill can result from the use of an out-of-network professional during a medical procedure. In the past, the medical professional could hold the patient accountable for the balance the insurance provider did not cover. Now, the law requires the health care provider to go through arbitration instead.
Lawmakers in both the House and Senate passed the law, praised by consumer advocates as one of the more “robust” set of protections for patients. It officially went into effect January 1, 2020.
The law could result in billing disputes. As such, it is likely wise for private practices in Texas to review billing practices to avoid issues and adjust as needed to better ensure compliance with the new law.