Taking on Out of Network Balance Billing
With thousands of Texans getting hit by surprise medical bills, eight organizations representing consumers, businesses, and health insurers have joined forces in support of legislative action to protect patients from unexpected and excessive health care costs.
These leading organizations, including Texas Association of Health Underwriters (TAHU), have come together to advance five key principles to ensure that patients get the care they need at costs they can afford.
“Too often, Texas health insurance consumers are getting slammed with surprise, out-of-network bills due to no fault of their own,” said Nicole Scott, President of TAHU. “Surprise billing from out of network doctors working at in network hospitals hurts patients and causes many of them severe financial harm. This year, the Texas Legislature has an opportunity to help by keeping Texas families out of the fray of billing disputes between insurers and medical providers and preventing surprise bills.”
Among organizations signing on to the principles are: AARP Texas, Center for Public Policy Priorities (CPPP), National Multiple Sclerosis Society, National Federation of Independent Businss (NFIB), Texas Association of Business (TAB), Texas Association of Life & Health Insurers (TALHI), Texas Association of Health Plans (TAHP), and the Texas Association of Health Underwriters (TAHU).
By signing onto these guiding principles, the organizations agree:
- Every consumer in Texas deserves affordable, high-quality coverage and care, and control over their health care choices.
- State legislative action is needed to protect consumers so that they are not financially penalized when they receive out-of-network care through no fault of their own. In these circumstances, providers should be prohibited by law from sending a surprise bill to a patient.
- Health care providers should be fairly compensated.
- The Department of Insurance should be able to identify and intervene if an insurer shows a pattern of paying unreasonably low amounts to out-of-network providers.
- State policy should restrain costs and ensure quality networks.
Patients should be informed when care is out of network. Patients should receive a notice that a provider is not in-network – and such a notice needs to be meaningful, timely, specific, and in plain language. The disclosure should provide patients with a meaningful opportunity to seek in- network care, and an estimate of the costs of out-of-network care.
The Texas Association of Health Underwriters (TAHU) represents more than 1,400 licensed health insurance agents and benefits professionals throughout the great State of Texas. TAHU members manage the health insurance needs of large and small employers as well as people seeking individual health insurance coverage. TAHU’s primary goal is to help promote access to affordable health insurance coverage. Our members help consumers by guiding them through the complexities of purchasing and enrolling in a health insurance plan, while ensuring they get the best policy at the most affordable price. We seek to understand each individual situation to create recommendations that complement a client’s financial and medical risk needs. However, our job does not end with the sale. Our members are committed to assisting their clients with claims issues, service questions and compliance matters for all of their clients.
To learn more, visit www.TAHU.org or follow @TAHU and on social media.
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