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A BILL TO BE ENTITLED
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AN ACT
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relating to what constitutes balance billing of a health benefit |
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plan enrollee by a physician or health care provider for purposes of |
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certain disclosure and medication requirements. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1456.001(1), Insurance Code, is amended |
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to read as follows: |
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(1) "Balance billing" means the practice of charging |
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an enrollee in a health benefit plan that uses a provider network to |
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recover from the enrollee the balance of a non-network health care |
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provider's fee for service received by the enrollee from the health |
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care provider that is not fully reimbursed by the enrollee's health |
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benefit plan. The term does not include charging for: |
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(A) any deductible, copayment, or coinsurance |
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amount for which the enrollee is obligated under the health benefit |
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plan; or |
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(B) any amount the health benefit plan is |
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obligated to reimburse the enrollee or to pay on behalf of the |
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enrollee for service received by the enrollee from the health care |
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provider. |
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SECTION 2. Section 1467.051(a), Insurance Code, is amended |
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to read as follows: |
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(a) An enrollee may request mediation of a settlement of an |
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out-of-network health benefit claim if: |
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(1) the amount charged to the enrollee through balance |
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billing as defined by Section 1456.001 [amount for which the
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enrollee is responsible to a facility-based physician, after
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copayments, deductibles, and coinsurance, including the amount
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unpaid by the administrator or insurer,] is greater than $500; and |
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(2) the health benefit claim is for a medical service |
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or supply provided by a facility-based physician in a hospital that |
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is a preferred provider or that has a contract with the |
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administrator. |
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SECTION 3. This Act takes effect September 1, 2017. |