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Texas Board of Nursing warns against balance billing

The Texas Board of Nursing (BON) recently reminded nurses of the consequences that can come with balance billing. Texas lawmakers recently changed the rules that govern balance billing, also known as surprise billing, with Senate Bill 1264. Lawmakers wrote the bill to protect consumers from unexpected medical bills and went into effect January 1, 2020.

How does the law work?

Balance bills refer to the balance left over after insurance covers its portion when a patient receives care from an out-of-network provider. The health care provider then generally sends the remaining balance to the patient. A common example lawmakers aim to avoid occurs when patients receive a medical procedure requiring anesthesia, only to later find out the anesthesiologist was out-of-network.

The law specifically bans balance billing for emergency procedures, but an exception is present for nonemergency procedures.

The law removes the patient from this dispute and requires the health care provider to find a resolution with the insurance company through the use of arbitration. It generally applies to state regulated health plans often held by teachers and other state employees as well as some who work for private employers. Insurance plans covered by this law will likely have a TDI or DOI imprint on the patient’s insurance card.

Who can hold health care providers accountable for a violation?

Health care providers that fail to abide by this change and send patients balance bills could be found in violation of the new law. Texas’ BON notes that the law allows regulatory agencies, like the BON, to hold practitioners accountable for violating the law.

What does this mean for nurses?

Although the Texas BON has not yet adopted these rules, a report of a violation could result in an investigation. An investigation by the BON could lead to a suspension or revocation of one’s nursing license. An attorney experienced in nursing license investigations can review the situation and discuss your options.