• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Print this page
You are here: Home . health . healthprices

Health Price Transparency

Consumer Rights    |    Reimbursement Rate Guide    |    Transparency Project 

Consumers' Rights to Health Care Price Estimates

Senate Bill 1731, enacted by the 80th Texas Legislature, created new rights for Texas health plan consumers to help them avoid unexpected health care bills. Consumers can request a cost estimate from a health care facility provider1, physician2, or from their health insurance company or HMO3 before receiving care. Carriers and health care providers must provide these estimates within 10 business days. Additionally, Texas law4 requires health carriers to use information technology to provide certain information to consumers, such as information on the "estimated financial responsibility for the health care provided to the enrollee." Many carriers have developed shopping tools that allow their enrollees to obtain estimates for the cost of certain services across in-network providers.

All of these tools, combined with Texas' network adequacy protections, help to mitigate the risk of balance billing. Consumers are encouraged to obtain cost estimates in advance of planned procedures and to ensure all providers involved in treatment are in-network.

Reimbursement Rate Guide

Senate Bill 1731 also directed the Texas Department of Insurance to collect and publish information from health carriers on the average billed charges and carrier reimbursement rates for certain health care services. TDI has implemented this requirement by creating a Reimbursement Rate Guide for consumers. Based on stakeholder feedback and a review of the data by experts at the University of Texas School of Public Health, TDI has found that much of the data submitted by carriers may not accurately reflect costs that consumers are likely to face. Until the data can be improved, TDI has removed some data from the website. Learn more about the data issues.

Project to Improve Health Price Transparency

TDI, in collaboration with the University of Texas School of Public Health, received a federal grant to promote health price transparency for Texas consumers and to support data resources for public health research.  Under this grant project, TDI is working to improve the quality and relevance of data provided to consumers through the Reimbursement Rate Guide.  TDI hosted stakeholder meetings in April and November of 2014 to discuss changes to the data collection methodology and to TDI's data collection rule at Title 28 Texas Administrative Code Chapter 21, Subchapter KK.  TDI published an informal draft of amendments to the rule and hosted a web meeting for stakeholder input in April 2015.  TDI published a formal rule proposal in November 2015 and posted supplementary resource documents, available here.

April 2014 Presentation

November 2014 Presentation

April 2015 Presentation

Endnotes:

  1. Health and Safety Code Section 324.101(d)
  2. Occupations Code Section 101.352(c)
  3. Texas Insurance Code Section 1456.007
  4. Texas Insurance Code Section 1661.002(b)


For more information, contact:

Last updated: 05/26/2016

Contact Information and Other Helpful Links