Under the new law, insurers and medical providers can enter into arbitration overseen by state officials to negotiate a payment.
For those that do not know what surprise billing is, it is when the medical provider bills you, the insured, for amount that exceeds what will be reimbursed by the insurance company.
Over the last few years surprised billing has become a big problem for people with insurance coverage. A good example of this is when you must go to the hospital for an emergency. The hospital may be in you network of approved providers but the doctors attending you may not be in the network. So, a couple of months after your emergency you receive a large bill from the medical provider because they felt they were not paid or not paid enough by the insurance company, so they want you to make up the difference, hence the SURPRISE BILL.
Texas currently has a mediation process for people to enter negotiations to get the bill lowered or removed. The problem with the process is there is a huge backlog of cases. To put the demand in perspective, the Texas Department of Insurance received just 43 requests for mediation in 2013. The following year, the number surged to more than 600 — and the numbers have climbed steeply ever since. The requests hit a record high of 4,519 in 2018, and regulators expect over 8,000 in 2019.
Now Gov. Greg Abbot has signed legislation that will remove the patient from the middle of the dispute between the insurance company and the medical provider. Starting on September 1, 2020, if the medical provider and insurance company cannot come to an agreement on a price, then they will go to arbitration and the state will oversee the process.
Although this is great news, there is always a BUT. The but in this case is that not all Texans will be protected by the new law. The Texas law does not apply to people who work for large employers whose plans are regulated by the federal government. In Texas, federally regulated plans account for roughly 40% of the state’s health insurance market.
