Balance billing strategy in the works for Texas healthcare.
By Admin | July 18, 2016
Insurance providers are shrinking their networks, and independent practices are claiming it makes them unable to compete in a market where they have no share.
Insurance companies counter by saying that smaller networks are the best way for them to lower their losses, and they’re increasingly refusing to pay out-or-network providers.
The result of the conflict is that many providers who are ineffective at negotiating rates with the insurance companies are engaging in balance billing, making the patients pick up the costs of care not covered by their insurers. This becomes a larger issue when 61 percent of physicians report being unable to negotiate fair rates with insurers.
Some doctors say balance billing is their only option to bolster profits.
A task force from the Texas Medical Association is pressuring insurers to expand their networks so practices don’t have to find other means of profit. In the next legislative session, they’re proposing more state agency oversight, expanding mediation processes, and for insurers to inform patients of their providers’ network statuses, among other things.