Tex.
Ins. Code Section 1456.004
Required Disclosure: Facility-based Physicians
(a)
If a facility-based physician bills a patient who is covered by a health benefit plan described in Section 1456.002 (Applicability of Chapter) that does not have a contract with the facility-based physician, the facility-based physician shall send a billing statement that:(1)
contains an itemized listing of the services and supplies provided along with the dates the services and supplies were provided;(2)
contains a conspicuous, plain-language explanation that:(A)
the facility-based physician is not within the health plan provider network; and(B)
the health benefit plan has paid a rate, as determined by the health benefit plan, which is below the facility-based physician billed amount;(3)
contains a telephone number to call to discuss the statement, provide an explanation of any acronyms, abbreviations, and numbers used on the statement, or discuss any payment issues;(4)
contains a statement that the patient may call to discuss alternative payment arrangements;(5)
contains a notice that the patient may file complaints with the Texas Medical Board and includes the Texas Medical Board mailing address and complaint telephone number; and(6)
for billing statements that total an amount greater than $200, over any applicable copayments or deductibles, states, in plain language, that if the patient finalizes a payment plan agreement within 45 days of receiving the first billing statement and substantially complies with the agreement, the facility-based physician may not furnish adverse information to a consumer reporting agency regarding an amount owed by the patient for the receipt of medical treatment.(b)
A patient may be considered by the facility-based physician to be out of substantial compliance with the payment plan agreement if payments are not made in compliance with the agreement for a period of 90 days.(c)
Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(1), eff. September 1, 2019.
Source:
Section 1456.004 — Required Disclosure: Facility-based Physicians, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1456.htm#1456.004 (accessed Jun. 5, 2024).
