| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the disclosure by health care practitioners and |
|
|
facilities of the price of certain health care services. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. The heading to Chapter 1456, Insurance Code, is |
|
|
amended to read as follows: |
|
|
CHAPTER 1456. DISCLOSURE OF PROVIDER STATUS AND PRICE |
|
|
SECTION 2. Section 1456.003(a), Insurance Code, is amended |
|
|
to read as follows: |
|
|
(a) Each health benefit plan that provides health care |
|
|
through a provider network shall provide notice to its enrollees |
|
|
that: |
|
|
(1) a facility-based physician or other health care |
|
|
practitioner may not be included in the health benefit plan's |
|
|
provider network; and |
|
|
(2) subject to Section 1456.008, a health care |
|
|
practitioner described by Subdivision (1) may balance bill the |
|
|
enrollee for amounts not paid by the health benefit plan. |
|
|
SECTION 3. Section 1456.007, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES. A |
|
|
health benefit plan that must comply with this chapter under |
|
|
Section 1456.002 shall, on the request of an enrollee, provide an |
|
|
estimate of payments that will be made for any health care service |
|
|
or supply and shall also specify any deductibles, copayments, |
|
|
coinsurance, or other amounts for which the enrollee is |
|
|
responsible. The estimate must be provided not later than the 10th |
|
|
business day after the date on which the estimate was requested. A |
|
|
health benefit plan must advise the enrollee that: |
|
|
(1) the actual payment and charges for the services or |
|
|
supplies will vary based upon the enrollee's actual medical |
|
|
condition and other factors associated with performance of medical |
|
|
services; and |
|
|
(2) subject to Section 1456.008, the enrollee may be |
|
|
personally liable for the payment of services or supplies based |
|
|
upon the enrollee's health benefit plan coverage. |
|
|
SECTION 4. Chapter 1456, Insurance Code, is amended by |
|
|
adding Section 1456.008 to read as follows: |
|
|
Sec. 1456.008. PRICE DISCLOSURE BY HEALTH CARE |
|
|
PRACTITIONERS AND FACILITIES. (a) At least 48 hours before |
|
|
providing a health care service other than emergency care, as |
|
|
defined by Section 1301.155, to a patient covered by a health |
|
|
benefit plan described by Section 1456.002, a health care |
|
|
practitioner or facility must disclose to the patient the price |
|
|
that will be accepted as payment in full for the service. The |
|
|
disclosure required by this section must be provided in writing in a |
|
|
readily understandable manner. |
|
|
(b) Notwithstanding another provision of this chapter or |
|
|
any other law, a health care practitioner or facility that does not |
|
|
make a disclosure required by this section before providing a |
|
|
health care service may not: |
|
|
(1) attempt to collect from the patient, by lawsuit or |
|
|
otherwise, any billed amount that would otherwise be owed by the |
|
|
patient for the service; or |
|
|
(2) furnish adverse information to a consumer |
|
|
reporting agency regarding any billed amount that would otherwise |
|
|
be owed by the patient for the service. |
|
|
(c) In addition to any other remedy provided by this chapter |
|
|
or other law, a health care practitioner or facility shall hold a |
|
|
patient harmless from any damages resulting from the practitioner's |
|
|
or facility's violation of this section. |
|
|
SECTION 5. The change in law made by this Act applies only |
|
|
to a service provided to an enrollee by a health care practitioner |
|
|
or facility on or after January 1, 2014. A service provided to an |
|
|
enrollee by a health care practitioner or facility before January |
|
|
1, 2014, is governed by the law in effect immediately before the |
|
|
effective date of this Act, and that law is continued in effect for |
|
|
that purpose. |
|
|
SECTION 6. This Act takes effect September 1, 2013. |