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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