From the Senator's Desk . . .
February 1, 2007
For many of us, trips to the doctor or hospital have turned into bills, calls, collectors, wrangling and even litigation. While the insurance company is quick to say what it will pay, it leaves it to you to pay the rest. This practice is called balance billing and Texans want it to stop.
Written by Senator Eliot Shapleigh, www.shapleigh.org
Making Health Care Work For You
How is health insurance supposed to work? Seems like the idea is that you get a policy, agree to a deductible and co—pays on services or drugs, then expect insurance to handle your bill. Right?
Wrong. For many of us, trips to the doctor or hospital have turned into bills, calls, collectors, wrangling and even litigation. While the insurance company is quick to say what it will pay, it leaves it to you to pay the rest. This practice is called balance billing and Texans want it to stop.
Under Texas law, balance billing should never occur if you use an HMO. As long as you stay within the HMO network, no balance billing issues should arise.
Outside the network, Texas law requires HMOs to provide medically necessary services. The HMO must then fully reimburse the non-network provider at the usual or customary rate. If you agree to payment terms in advance, then you should not have balance billing issues.
We have had many of you ask us about this issue. Several of us are working this session to pass legislation to stop balance billing abuse.
Have questions? Call the Texas Department of Insurance consumer hotline at 1-800-252-3439.Keep the faith,
Senator Eliot Shapleigh
