On June 14, Texas joined the ranks of a score of states with consumer protections against surprise billing (or balance billing) with the signing of Senate Bill 1264.
Effective this September, the bulk of the bill focuses on three areas: limitations on surprise billing information reported by consumer reporting agencies, elimination of surprise billing for specific health plans, and mandatory mediation requests. Of particular interest to providers and payers in the last item.
Under the new legislation, mediation no longer involves the patient and instead takes place between the health plan administrator or issuer and the provider and is overseen by an impartial mediator. Arbitration applies to amounts exceeding $500 and services rendered in emergency departments or medical care provided within a facility that is a preferred provider.