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Texas' new surprise billing legislation — 4 insights for ASCs

Texas recently passed legislation that generally prohibits the practice of balance billing in cases where patients can't choose their medical provider, according to law firm Gray Reed.

Four insights:

1. The balance-billing ban applies when the service rendered to a patient is covered by the patient's benefit plan.

2. In cases where a patient knowingly selects an out-of-network physician for elective services, the physician must have the patient sign a waiver acknowledging the possibility that services will cost more.

3. Three kinds of out-of-network providers must utilize the balance-billing waiver when covered services are provided:

  • Facility-based providers (including those who treat ASC patients)
  • Diagnostic imaging providers
  • Laboratory service providers

4. When an out-of-network provider renders a service that isn't covered by the patient's benefits plan, the provider may bill the patient without obtaining a waiver.

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