Health Insurance Transparency

The Texas Association of Freestanding Emergency Centers supports recent legislation introduced in the Texas Legislature aimed at increasing oversight of health insurance companies and protecting consumers from surprise medical costs.

Increased Health Insurance Transparency

A recent poll 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 HB 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, HB 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 SB 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 HB 2620, which would award damages and court costs to the plaintiff in disputes regarding prohibited acts or practices by insurers.

TAFEC also supports HB 2942 filed by Rep. Munoz Jr., HB 2945 by Rep. Munoz Jr., SB 1485 by Sen. Donna Campbell, HB 3755 by Rep. Rodney Anderson, and SB 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 HB 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 (SB 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.

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