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Senate Bill 1264 |
Senate Author: Hancock et al. |
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Effective: 9-1-19 |
House Sponsor: Oliverson et al. |
Senate Bill 1264 amends the Insurance Code to establish consumer protections against balance billing by certain out‑of‑network providers. The bill prohibits those providers from billing health benefit plan enrollees for certain covered health care services or supplies in an amount greater than an applicable copayment, coinsurance, or deductible under the plan and provides for the right of those providers to receive payment for those services or supplies at the usual and customary rate or at an agreed rate. Among other provisions, the bill provides for a balance billing prohibition notice, the authority of the attorney general to bring a civil action to enjoin a violation of the balance billing prohibitions, and the enforcement of balance billing prohibitions by an appropriate regulatory agency.
Senate Bill 1264 also revises the procedures for out‑of‑network claim dispute resolution. Among other provisions, the bill removes enrollees from the process, establishes mediation procedures for disputes involving out‑of‑network facilities and arbitration procedures for disputes involving out‑of‑network providers that are not facilities, and requires the commissioner of insurance to establish corresponding mediation and arbitration programs.
Senate Bill 1264 requires the Texas Department of Insurance to conduct a biennial study on the impacts of the bill on Texas consumers and health benefit coverage in Texas.