A commercially insured patient who unknowingly receives out-of-network care in an emergency or at an in-network facility may face a “surprise bill” for the balance between the clinician’s charge and the insurer’s out-of-network allowed amount. Texas prohibited surprise bills for out-of-network emergency services and nonemergency ancillary services at in-network facilities among fully insured health plan enrollees, effective January 1, 2020.1 Under this law, patients pay in-network cost sharing and health plans and out-of-network clinicians or emergency facilities resolve payment disagreements through an independent dispute resolution (IDR) process. The law provides different processes for facility and clinician services. New research published in JAMA, looks at dispute resolution outcomes for Surprise Bills in Texas with a focus on clinicians.
- Dispute Resolution Outcomes for Surprise Bills in Texas. JAMA. June 21 2022.
- Texas Department of Insurance: How consumers are protected from surprise medical bills