Tex.
Occ. Code Section 101.352
Billing Policies and Information; Physicians
(a)
A physician shall develop, implement, and enforce written policies for the billing of health care services and supplies. The policies must address:(1)
any discounting of charges for health care services or supplies provided to an uninsured patient that is not covered by a patient’s third-party payor, subject to Chapter 552 (Illegal Pricing Practices), Insurance Code;(2)
any discounting of charges for health care services or supplies provided to an indigent patient who qualifies for services or supplies based on a sliding fee scale or a written charity care policy established by the physician;(3)
whether interest will be applied to any billed health care service or supply not covered by a third-party payor and the rate of any interest charged; and(4)
the procedure for handling complaints relating to billed charges for health care services or supplies.(b)
Each physician who maintains a waiting area shall post a clear and conspicuous notice of the availability of the policies required by Subsection (a) in the waiting area and in any registration, admission, or business office in which patients are reasonably expected to seek service.(c)
On the request of a patient who is seeking services that are to be provided on an out-of-network basis or who does not have coverage under a government program, health insurance policy, or health maintenance organization evidence of coverage, a physician shall provide an estimate of the charges for any health care services or supplies. The estimate must be provided not later than the 10th business day after the date of the request. A physician must advise the consumer that:(1)
the request for an estimate of charges may result in a delay in the scheduling and provision of the services;(2)
the actual charges for the services or supplies will vary based on the patient’s medical condition and other factors associated with performance of the services;(3)
the actual charges for the services or supplies may differ from the amount to be paid by the patient or the patient’s third-party payor; and(4)
the patient may be personally liable for payment for the services or supplies depending on the patient’s health benefit plan coverage.(d)
For services provided in an emergency department of a hospital or as a result of an emergent direct admission, the physician shall provide the estimate of charges required by Subsection (c) not later than the 10th business day after the request or before discharging the patient from the emergency department or hospital, whichever is later, as appropriate.(e)
A physician shall provide a patient with an itemized statement of the charges for professional services or supplies not later than the 10th business day after the date on which the statement is requested if the patient requests the statement not later than the first anniversary of the date on which the health care services or supplies were provided.(f)
If a patient requests more than two copies of the statement, a physician may charge a reasonable fee for the third and subsequent copies provided. The Texas Medical Board shall by rule set the permissible fee a physician may charge for copying, processing, and delivering a copy of the statement.(g)
On the request of a patient, a physician shall provide, in plain language, a written explanation of the charges for services or supplies previously made on a bill or statement for the patient.(h)
If a patient overpays a physician, the physician must refund the amount of the overpayment not later than the 30th day after the date the physician determines that an overpayment has been made. This subsection does not apply to an overpayment subject to Section 1301.132 (Overpayment) or 843.350 (Overpayment), Insurance Code.(i)
In this section, “physician” means a person licensed to practice in this state.
Source:
Section 101.352 — Billing Policies and Information; Physicians, https://statutes.capitol.texas.gov/Docs/OC/htm/OC.101.htm#101.352 (accessed Jun. 5, 2024).
