A Texas law that takes effect Tuesday is designed to help patients negotiate lower bills from hospital-based doctors who aren't in their health insurer's provider network.
The current law states that an "out of network" bill from an anesthesiologist, radiologist, emergency room doctor or pathologist must exceed $1,000 before the Texas Department of Insurance can get involved. The revised law lowers the minimum bill to $500. State Sen. Kelly Hancock, a Tarrant County republican, sponsored the updated law.
The new law will allow hospital patients with bills of $500 or higher to get the Texas Department of Insurance's help in billing disputes when otherwise they have no recourse but to pay or have their account turned over to a collection agency.
Stacey Pogue, a health insurance expert at the Center for Public Policy Priorities, a center-left think tank, supported the new law. She said in 9 out of 10 cases when the Texas Department of Insurance gets involved, an agreement is reached on the phone.
If a phone call does not lead to an agreement, the state's chief administrative law judge will name an impartial mediator to work out a deal between the insurer and the doctor and the two parties bear any costs. If that fails, the case can go to an administrative law judge. The Dallas Morning News first reported about the new law.
