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Senate Bill 507 |
Senate Author: Hancock et al. |
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Effective: 9-1-17 |
House Sponsor: Frullo et al. |
Senate Bill 507 amends the Insurance Code to apply statutory provisions relating to out‑of‑network health benefit claim dispute resolution to an administrator of a health benefit plan other than a health maintenance organization plan under the Texas Public School Retired Employees Group Benefits Act or the Texas School Employees Uniform Group Health Coverage Act. The bill extends the availability of mandatory mediation under those statutory provisions to claims meeting the statutory amount threshold that are for emergency care or for a health care or medical service or supply provided by any facility-based health care provider in an ambulatory surgical center, birthing center, hospital, or freestanding emergency medical care facility that is a preferred provider or that has a contract with an applicable plan administrator. The bill makes specified duties and responsibilities of the Texas Medical Board under such statutory provisions applicable to any other appropriate regulatory agency. The bill requires a bill sent to an enrollee by a facility-based provider or emergency care provider or an explanation of benefits sent to an enrollee by an insurer or administrator for an out-of-network health benefit claim eligible for mediation to contain a specified notice with an explanation of the mediation process and information on how to request mediation. The bill repeals the requirement for a mediator to report bad faith mediation to the commissioner of insurance or the Texas Medical Board, as appropriate, following the conclusion of the mediation.