Texas Surprise Billing Law: January 1, 2020

The 2019 Texas Legislature passed SB 1264, which creates a ban on surprise billing (bills beyond the co-insurance, co-payment, and deductible) for out-of-network care.

SB 1264 does create a small exception in which a physician may surprise bill if a patient is presented a financial estimate for consideration at least 10 business days prior to a service. The patient has a certain amount of time to consider it.

The Texas Department of Insurance (TDI) created forms for the exception.

For cases in which there is a dispute between a physician and a health plan for an out-of-network payment, an arbitration process has been created.

Keep in mind that the state of Texas only has jurisdiction over certain types of commercial health plans sold in the Texas market, such as Obamacare plans and state employee plans. Only the federal government has jurisdiction over ERISA plans, and the federal government has yet to enact a similar ban on surprise billing for ERISA plans.

Click here for complete details from TDI.