The Texas Medical Association is deeply skeptical of a state senator’s freshly filed effort to prevent physicians from balance billing patients for the services they provide.
On Thursday, Sen. Kelly Hancock (R-North Richland Hills) filed Senate Bill 1264, a measure to address surprise out-of-network medical bills. The legislation emerged with no input from the House of Medicine.
TMA President Doug Curran, MD, said upon initial review, SB 1264 appeared to be a “window-dressing” measure to protect patients from out-of-network bills.
According to a release from Senator Hancock’s office, SB 1264 would “allow medical providers and facilities to directly trigger an existing Texas Department of Insurance (TDI) balance bill mediation program” to negotiate payments with insurers, “while prohibiting them from sending surprise balance bills to customers.” The current mediation process allows patients to mediate many out-of-network balance bills higher than $500.
“Thousands of Texans receive unexpected, and frankly unreasonable, surprise medical bills every year,” Senator Hancock said in the release. “Mediation works when it’s available and has saved Texas patients more than $30 million in out-of-pocket health care expenses. But they’re still getting stuck in the middle of payment negotiations, with no choice over care or control over costs. It's time to change that.”
Dr. Curran said the bill takes the wrong approach to curbing surprise bills.
“Allowing health plans and their overcompensated CEOs to skirt responsibility for the products they sell to Texas consumers and employers only legitimizes the inadequate networks the plans currently use,” he said. “Furthermore, this legislation allows health plans to unilaterally determine what is paid for doctors’ care to patients. This is no better than a single-payer, big government solution.
“Real and long-term patient protection requires holding health plans accountable for the networks they sell and not letting them off the hook only to further their profits. The state should push health plans to include more physicians in their networks and not give them an incentive to further narrow their skimpy networks.”
In 2009, then-State Representative Hancock sponsored House Bill 2256, which established the mediation program for patients to resolve disputes over out-of-network, facility-based physician claims for treatment at in-network facilities. That bill also requires state insurance officials to adopt and enforce network adequacy standards.
Senator Hancock’s SB 507, a TMA-backed measure in 2017, opened up the mediation process to many more out-of-network practitioners at in-network facilities.