A new Texas law that aims to protect patients from receiving surprise medical bills takes effect this week. Consumer advocates have praised the law as one of the most robust set of billing protections in the nation, though it only applies to about one-third of Texans with private health insurance.
The intent of Senate Bill 1264 is to remove patients from billing disputes between state-regulated health insurance plans and health care providers.
Previously, when a health insurer declined to pay the full price charged by an out-of-network doctor for a medical procedure, the doctor could bill the patient for the remainder, or balance, of the cost. Such “balance bills” often took patients by surprise. For example, a patient who received surgery at a hospital within his or here health insurance network might unknowingly receive care from an out-of-network anesthesiologist, who could send the patient an expensive balance bill if the insurer declined to pay the anesthesiologist’s full rate.
Now, insurers and health care providers must leave the patient out of billing disputes and negotiate prices for out-of-network care using an arbitration process.