Bill Text: TX HB3755 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to payment standards for preferred provider benefit plans to reduce balance billing of insureds for out-of-network health care services.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-04-25 - Left pending in committee [HB3755 Detail]
Download: Texas-2017-HB3755-Introduced.html
85R2665 BEE-F | ||
By: Anderson of Dallas | H.B. No. 3755 |
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relating to payment standards for preferred provider benefit plans | ||
to reduce balance billing of insureds for out-of-network health | ||
care services. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subchapter C-1, Chapter 1301, Insurance Code, is | ||
amended by adding Section 1301.140 to read as follows: | ||
Sec. 1301.140. BALANCE BILLING; PAYMENTS TO OUT-OF-NETWORK | ||
PROVIDERS. (a) In this section, "geozip area" means an area that | ||
includes all zip codes with the identical first three digits. For | ||
purposes of this section, a covered service performed at a location | ||
that does not have a zip code is considered to be performed in the | ||
geozip area closest to the location at which the service is | ||
performed. | ||
(b) An insurer may not cause balance billing of an insured | ||
by paying an out-of-network provider based on an allowed charge for | ||
a covered service that is less than the average amount billed for | ||
the service by preferred providers in the geozip area in which the | ||
service was provided. | ||
(c) If an out-of-network provider submits to an insurer a | ||
claim for payment for a covered service, the insurer shall pay the | ||
out-of-network provider an amount that is equal to or greater than | ||
the average amount billed for the service by preferred providers in | ||
the geozip area in which the service was provided minus any portion | ||
of the charge that is the insured's responsibility under the | ||
preferred provider benefit plan. | ||
SECTION 2. Section 1301.140, Insurance Code, as added by | ||
this Act, applies only to a preferred provider benefit plan that is | ||
delivered, issued for delivery, or renewed on or after January 1, | ||
2018. A preferred provider benefit plan that is delivered, issued | ||
for delivery, or renewed before January 1, 2018, is governed by the | ||
law as it existed immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 3. This Act takes effect September 1, 2017. |