Comments: Proposed Rule Reduces Transparency in Health Insurance Balance Billing

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Stacey Pogue /(512) 320-0222 x 117

September 3, 2012

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When consumers are treated by doctors who are not part of their health insurance’s network, they may be billed by the doctor for everything insurance did not cover – a practice called balance billing. Even diligent consumers who carefully check whether providers take their insurance can end up unexpectedly being treated by an out-of-network provider and balance billed.

The center submitted comments on how to strengthen consumer protections in the Texas Department of Insurance’s proposed rules relating to network adequacy and balance billing in PPOs and exclusive provider organizations. The center opposes proposed amendments that weaken disclosure and transparency provisions and supports amendments that clarify how insurers must credit the amounts consumers pay out-of-pocket (for deductibles and balance bills). The center also recommends stronger network adequacy protections for exclusive provider organizations.