Rule implementing a new Texas law against surprise medical billing may narrow the law’s protections

Texas enacted a law in 2019 to protect people in state-regulated health plans from surprise medical billing — that is, outrageous bills for out-of-network care. The law, which goes into effect in January, creates an arbitration process for insurers and providers to negotiate so that fair prices are charged without involving patients.

Rules implementing the law, however, may allow hospitals and other care providers to avoid the law in some situations, such as scheduled surgeries, by broadly expanding an exception in the law for for of-network non-emergency costs. Using that exemption — intended to be used only when patients want a particular out-of-network doctor — a proposed rule would require all out-of-network providers in non-emergency situations to give patients a form waiving the protections of the law.

Patient advocates are concerned that the rule would essentially require out-of-network providers, like anesthesiologists and pathologists, to give patients a confusing form that waives their right to the new law's protection.

NPR has the story, here.

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