Texas Closes Loophole on Surprise Medical Bills

Beginning January 1, Texas is now a state with one of the strongest protections against surprise medical bills. In 2019, the Texas legislature drafted a bill to protect state residents who use state regulated health plans from receiving significant, and in some cases outrageous, medical bills for care performed out of network. The bill was passed to the Texas Medical Board to draft the rules of implementation, but the Board attempted to create a loophole with a blanket exception for almost all non-emergency cases.

After serious outcry from state legislators and citizens, the Texas Medical Board agreed to relinquish control over writing the implementation rules for the new law over to the Texas Department of Insurance. The department released their finalized list of rules at the end of December that are meant to protect consumers utilizing Texas medical professionals. The crux of the new regulations is that patients who have in-network health plans should never be forced to sign away their protections and pay much higher rates for out-of-network care if there is no reasonable alternative or incomplete information about their options.

The new regulations require that a patient choosing an out-of-network provider for medical care first sign a document that states that the patient may pay more for that out of network care. This form is now required in Texas before any non-emergency medical procedure. Furthermore, a new Texas bill protects patients from surprise medical bills from out-of-network providers in cases in which the patient cannot choose which healthcare professional provides his or her medical care. Instead, the proposed law creates an arbitration system between insurers and providers to negotiate the cost of out-of-network medical care that eliminates the current practice of patients receiving a surprise bill when the two sides cannot agree on a fair price.

How These New Laws Affect You

The purpose of these new medical laws in Texas is to ensure that patients are fully informed before choosing out-of-network providers and protecting patients from receiving outrageous surprise medical bills for out-of-network care. If you see a healthcare professional for a nonemergency medical procedure and select an out-of-network provider without being informed of the potential costs, you might have a legal case. In addition, if you required emergency care and had no input on an out-of-network healthcare provider treating your medical issue, you are protected from receiving a surprise bill in the mail later. The new laws require that the insurance company and healthcare provider arbitrate the cost of those services. If you receive a significant medical bill in the mail, you need to talk with an attorney as soon as possible.


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