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.
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 Texas Healthcare Costs 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.