Collector - January 2018 - 48
Texas Law Expands Protections for Medical Account Mediation
New protections apply to certain healthcare claims incurred on or after Jan. 1, 2018.
By Kim Rath
he New Year rings in new protections
for certain medical claims. Last
year, Texas Gov. Greg Abbott signed
legislation to expand the existing law dealing
with balance billing, which occurs when
patients are directly billed by a provider for
the portion of medical expenses not covered
by their insurance. This can happen when
insured patients receive out-of-network
care, often in an emergency care situation or
when a patient is admitted to an in-network
facility, but receives treatment from an outof-network provider.
Texas developed a mediation system
back in 2009 to assist consumers in
resolving certain balance bills and made
improvements to the system in 2015, and
most recently again in 2017.
The most recent legislation, which
applies to claims incurred after Jan. 1, 2018,
broadens the types of accounts that are
eligible for mediation protections already
used by insured consumers in Texas on a
limited basis. The newest law expands access
to mediation eligibility to all out-of-network
providers treating patients at in-network
hospitals and other facilities.
Before the latest revisions, the existing law
made mediation available to consumers who
were balance billed by only six types of facilitybased providers: radiologists, anesthesiologists,
pathologists, emergency department
physicians, neonatologists and assistant
surgeons. The law also provides for mediation
of balance bills for emergency care from any
provider or facility of emergency services care,
including free-standing emergency rooms.
In an effort to bolster awareness of the
mediation program, the new law also
institutes a new disclosure requirement to
inform consumers of their mediation rights.
Healthcare providers and other facilities
must include a statement substantially
similar to the following: "You may be able
to reduce some of your out-of-pocket costs
for an out-of-network medical or health
care claim that is eligible for mediation
by contacting the Texas Department
of Insurance at [website] and [phone
number]" on bills that are eligible for
mediation. The disclosure must be in at
least 10-point boldface type.
Healthcare providers and servicers should
make sure they are familiar with the new
balance billing requirements that apply to
certain healthcare claims incurred on or after
Jan. 1, 2018, and determine how they will
impact current billing practices.
Please note that the above-referenced
legislation, S.B. 507, became law on Sept.
1, 2017, and applies to healthcare claims
incurred after Jan. 1, 2018.
Kim Rath is ACA International's director of