Senate bill 507 recently passed and there’s a lot of information circulating about what it means for patients and the billing process. At Tyvan Billing, we always aim to be as transparent as possible, which is why we’re going to break down this bill’s impact on the billing and mediation process.
The Changes
Senate bill 507, which was passed in March and approved by the House Insurance Committee in early May, requires all freestanding facilities and other out-of-network providers to enter into a mediations process when surprise bills are sent to patients after treatment. These “surprise bills,” more commonly known as “balance billing,” are the direct result of insurance companies refusing to honor emergency benefits.
Balance Billing
While our partnered facilities do not balance bill our patients, many freestanding facilities and other out-of-network providers do. Balance bills are essentially, the “leftover” treatment costs that your insurance provider has refused to pay. These predatory actions, which saddle large amounts with the patient, are enabled by vague verbiage in Texas laws. Current regulations only require insurance providers to pay “usual and customary” benefits to emergency facilities, but “usual and customary” has never been defined.
To learn more about balance billing, visit this page.
Mediations Process
The new bill places the responsibility of mediation and financial resolution largely in the hands of the medical facilities. This allows insurance companies to avoid honoring emergency care benefits and ultimately, mislead patients about their benefits.
If you choose to move forward with the mediations process, the meeting will be held within 180 days of your request. It’s important to remember that you have a right to a state-appointed mediator, or if both parties choose, an independent mediator.
“The parties are not required to to reach an agreement in mediation but if no agreement is made, the matter may be referred to a special judge for solution,” said La Toyia Laws, Director of Operations at Tyvan Billing. “Requesting mediation does not limit your ability to take the matter to court after the mediations process if a resolution isn’t met.”
Requesting mediation does not mean you’re no longer responsible for your treatment costs.
“Instead, the goal of the mediation is to reach an agreement between you, your physician and the carrier as to the amount charged by the physician, the amount paid by the carrier to the physician and the amount paid by you,” Laws said.
Your physician or the out-of-network facility may not attempt to collect payment until the mediation ends.
We get it. Billing, especially medical billing, is complicated and often overwhelming – that’s why our team is available for any questions you have regarding your emergency care costs. We’ll work tirelessly to ensure you’re receiving the benefits you deserve from your insurance provider.
Visit this page to file a claim to the Texas Department of Insurance.
Still have questions? Visit our FAQ page or speak with one of our team members at (713) 357 – 2535 to address any of your concerns.
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