Texas 2025 - 89th Regular

Texas House Bill HB4872

Voted on by House
 
Out of Senate Committee
 
Voted on by Senate
 
Governor Action
 
Bill Becomes Law
 

Caption

Relating to the calculation of penalties for violating certain laws governing the prompt payment of claims submitted by a physician or health care provider to certain health benefit plan issuers.

Impact

The proposed changes will primarily impact the existing laws regarding prompt payment of claims. By establishing a uniform guideline for what constitutes the 'contracted rate', the bill seeks to standardize the approach to calculating penalties across the state. This could lead to more consistent practices among health benefit plan issuers and may strengthen the financial position of healthcare providers in Texas, especially in scenarios where timely payments are not forthcoming.

Summary

House Bill 4872 aims to amend the Insurance Code in Texas, focusing on the calculation of penalties for health benefit plan issuers that fail to promptly pay claims submitted by physicians or healthcare providers. Specifically, the bill outlines that for assessing these penalties, the relevant contracted rate for healthcare services will be defined as the usual and customary rate for the service in the geographic area where the services are rendered. This adjustment is designed to enhance clarity and ensure fair compensation for healthcare providers in cases of delayed payments.

Contention

While the bill seems to position itself as a protective measure for healthcare providers, there may be contention surrounding how health benefit plan issuers will adapt to these changes. Stakeholders might have differing perspectives on what defines 'usual and customary' rates, and disputes could arise over the interpretation of these guidelines. Additionally, some critics may argue that this could lead to increased costs for health benefit plan issuers, potentially affecting premium rates for consumers.

Companion Bills

No companion bills found.

Previously Filed As

TX SB926

Relating to certain practices of health benefit plan issuers to encourage the use of certain physicians and health care providers and rank physicians.

TX HB1959

Relating to certain practices of health benefit plan issuers to encourage the use of certain physicians and health care providers and rank physicians.

TX HB3863

Relating to the form of a claim payment to a health care provider by a health maintenance organization, preferred provider benefit plan, or managed care organization.

TX HB1298

To Modify Payment Of Benefits For Certain Healthcare Providers Under A Health Benefit Plan.

TX HB1687

Relating to out-of-pocket expense credits for payments made directly to a physician or health care provider by an enrollee of a governmental employee health benefit plan.

TX HB2641

Relating to health benefit plan preauthorization requirements for physicians and providers providing certain health care services.

TX SB1443

Health benefit plans; requiring certain health benefit plans to consider certain factors when determining payments for services. Effective date.

TX SB1411

Relating to the use of artificial intelligence-based algorithms by health benefit plan issuers, utilization review agents, health care providers, and physicians.

TX SB1380

Relating to health benefit plan preauthorization requirements for participating physicians and providers providing certain health care services.

TX H1231

Insurance Claims Payments to Physicians

Similar Bills

No similar bills found.