Skip to main content

Analysis

Consumer Balance Billing Complaints in Texas Down in Wake of New Law

By Alexandra Wilson Pecci  
   August 03, 2020

The Texas Department of Insurance received just 19 consumer complaints about balance billing during the first six months of 2020, down from 546 for the same period in 2019.

Consumer complaints from Texans about balance billing dropped dramatically in the first six months of 2020 since the state implemented its new balance billing legislation.

A preliminary report from the Texas Department of Insurance (TDI) shows that the department received just 19 consumer complaints about balance billing during the first six months of 2020, down from 546 for the same period in 2019.

The law, SB 1264, applies to about 20% of Texans: Those who are in insurance plans regulated by TDI and people with coverage through the state employee or teacher retirement systems.

It prevents surprise medical billing for patients in situations where they have no choice which provider they see.

It also created two billing dispute resolution processes: mediation for facilities and labs and arbitration for physicians and other similar providers. Previously, consumers could request mediation for certain surprise bills, but for providers, filing a complaint was the only recourse available through TDI to resolve billing disputes.

The new protections apply to bills for medical services received on or after January 1, 2020, so TDI says it didn't receive its first arbitration request until February 12, 2020. The number of complaints rose each month from there.

The report notes that these results are preliminary. It also points out that "the ban on elective surgeries due to the COVID-19 pandemic may have reduced the number of requests for mediation and arbitration that TDI would have otherwise received for out-of-network providers at in-network facilities."

The report also shows that in the first six months:

  • About 85% of dispute resolution requests are coming from three large physician staffing and billing firms
     
  • Provider complaints have decreased more than 70%
     
  • TDI received 1,770 complaints from healthcare providers and billing services in the first six months of 2020, down from 6,461 for the same period in 2019
     
  • TDI is seeing a higher proportion of requests related to emergency services than in the previous mediation system. The elective surgery ban may be a factor in this difference, the report says.

Read the full report here.

Alexandra Wilson Pecci is an editor for HealthLeaders.


Get the latest on healthcare leadership in your inbox.