Bill Text: TX SB1615 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to what constitutes balance billing of a health benefit plan enrollee by a physician or health care provider for purposes of certain disclosure and medication requirements.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-03-21 - Referred to Business & Commerce [SB1615 Detail]
Download: Texas-2017-SB1615-Introduced.html
85R9205 SMT-F | ||
By: Campbell | S.B. No. 1615 |
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relating to what constitutes balance billing of a health benefit | ||
plan enrollee by a physician or health care provider for purposes of | ||
certain disclosure and medication requirements. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1456.001(1), Insurance Code, is amended | ||
to read as follows: | ||
(1) "Balance billing" means the practice of charging | ||
an enrollee in a health benefit plan that uses a provider network to | ||
recover from the enrollee the balance of a non-network health care | ||
provider's fee for service received by the enrollee from the health | ||
care provider that is not fully reimbursed by the enrollee's health | ||
benefit plan. The term does not include charging for: | ||
(A) any deductible, copayment, or coinsurance | ||
amount for which the enrollee is obligated under the health benefit | ||
plan; or | ||
(B) any amount the health benefit plan is | ||
obligated to reimburse the enrollee or to pay on behalf of the | ||
enrollee for service received by the enrollee from the health care | ||
provider. | ||
SECTION 2. Section 1467.051(a), Insurance Code, is amended | ||
to read as follows: | ||
(a) An enrollee may request mediation of a settlement of an | ||
out-of-network health benefit claim if: | ||
(1) the amount charged to the enrollee through balance | ||
billing as defined by Section 1456.001 [ |
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(2) the health benefit claim is for a medical service | ||
or supply provided by a facility-based physician in a hospital that | ||
is a preferred provider or that has a contract with the | ||
administrator. | ||
SECTION 3. This Act takes effect September 1, 2017. |