Opponents to the rules said they offered a loophole that could have cost patients money.
Now, the TMB has redrawn its rules surrounding Senate Bill 1264, commonly known as the "surprise medical billing law."
"Because, as it stands, it would not cover all the providers it would need to cover under the statue," TMB President Sherif Zaatran said. "It would really only cover about 85% of providers under the statue and not everyone that it should."
"They're looking for an agency that can come and step in and create rules that make sure they cover everybody ... and I think that's probably the best way to do it," said Blake Hutson with AARP Texas. "It seems to point to the Department of Insurance, you know, they're the ones who have the most experience in protecting consumers in health insurance plans to make sure the laws work as they're intended."
Opponents like Hutson said that the form the TMB had suggested to deal with that problem would have created a loophole and patients would be left with little to none of the protections the law was there to create, to keep them from getting huge medical bills that they weren't expecting.
So the TMB voted against those forms.
"It shouldn't be a big loophole, and we're hopeful that whoever makes the final rules on this will get it right," Hutson said.
"As the statute goes into effect [on] Jan. 1, we will try to put some direction out there until all these things are looked at by the other state agencies," Zaatran said.
Even though this decision was made, there will still be more decisions needed moving forward.
On Wednesday, the Department of Insurance adopted a rule outlining the narrow exception to SB 1264.
The new TDI rule:
- Clarifies that consumers can waive SB 1264 balance billing protections only in cases where they have a choice between an in-network provider and an out-of-network provider. The waiver can’t be used in an emergency or when an out-of-network doctor was assigned to a case, such as when an anesthesiologist is assigned to a surgery.
- Includes the form consumers must sign at least 10 business days before receiving out-of-network care if the provider wants to balance bill the consumer instead of requesting arbitration or mediation.
- Applies only to state-regulated insurance plans and people with coverage through the state employee or teacher retirement systems. Insurance cards for state-regulated plans have either “DOI” (for department of insurance) or “TDI” (Texas Department of Insurance) printed on them. It does not apply to self-funded employer-sponsored health plans or Medicare.
According to the department, the rule is adopted on an emergency basis. For more information, visit the Department of Insurance's website.
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