Insights

Texas Department of Insurance Releases Survey on Balance Billing Issue


The Texas Department of Insurance (TDI) released the results of a survey that looked at out-of-network payments by preferred provider organizations (PPOs) for certain services. The survey looked only at PPO services because consumers in those plans may be balance billed even for emergency services – meaning the consumer may be responsible for the amount not paid by the plan. The survey found that most plans comply with the state requirement to pay such claims “at the usual or customary charge for the service.” Under Texas law, consumers with health plans regulated by TDI can request mediation for balance bills that exceed $500 for care provided at an in-network hospital. This applies only to fully insured plans.

Usual and Customary Survey »