State Adopts Emergency Rule on Surprise Billing Law 

AUSTIN January 7, 2019 - The Texas Department of Insurance (TDI) has adopted an emergency rule outlining the narrow circumstances when it will be legal for physicians to balance bill patients under the state’s new law that protects patients from surprise medical bills.

And the Texas Medical Board (TMB) is telling physicians to accept how TDI interprets the law in its emergency rule.

Senate Bill 1264 – the baseball-style arbitration law applying to state-regulated plans and certain out-of-network medical care from Jan. 1 onward – prohibits affected physicians from balance billing except in some nonemergency circumstances, as outlined in the Texas Medical Association’s new summary of the law. That exception includes a written disclosure physicians must provide a patient before the out-of-network care is delivered.

TDI adopted its emergency rule Wednesday, saying in a release that it clarifies patients can waive the protections of SB 1264 “only in cases when they have a choice between an in-network provider and an out-of-network provider. The waiver can’t be used in an emergency or when an out-of-network doctor was assigned to a case, such as when an anesthesiologist is assigned to a surgery.” The rule also includes the relevant waiver form, which patients must sign at least 10 business days before receiving the out-of-network care in order for the exception to apply.

Also Wednesday, TMB released a “guidance statement” saying physicians and practitioners “under the authority and oversight of TMB, who seek to exercise the exceptions to the prohibitions against balance billing must comply with all provisions of SB 1264, including as interpreted by TDI rules.” 

TMB, which pulled down proposed rules related to SB 1264’s exception earlier this month, said it would “work on development of rules consistent with TDI’s rules.”

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