SB 1264: BALANCE BILLING

Balance billing generally comes about when an insured patient needs to seek emergency care from an out-of-network facility or when they go to an in-network hospital but later find out that their doctor or some other provider they saw during that visit was actually out of network.  In these situations, if the insurance company and providers cannot negotiate a price, the patient may be left with a substantial medical bill.

In 2009, the state passed HB 2256, which set up a mediation process that consumers could initiate.  The Texas Department of Insurance estimates that this process has saved consumers almost $36 million since 2015; however, consumers may not be aware that this process even exists.

For state-regulated insurance plans, SB 1264 creates an arbitration process between providers and insurers and leaves the consumer completely out of the negotiations.  The law also gives the state the authority to enforce the results of the arbitration.  State Representative Trey Martinez Fisher (D-San Antonio) stated, "SB 1264 also adds two new enforcement mechanisms: administrative penalties by the relevant state agencies and the ability for the AG’s office to seek an injunction against perennial bad actors."

Texas has taken a lead on combating this issue, and we may also see national action, such as the bipartisan No Surprises Act.