Highlights 77th Texas Legislature - Senate

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Prompt Pay for Physicians - H.B. 1862
by Representative Eiland, et al.
Senate Sponsor: Senator Van de Putte
INSURANCE
77 th Texas Legislature
Claims sent by physicians to health maintenance organizations or preferred provider organizations (health
care plan provider) for payment may not be paid in a timely manner. The statutory limit of 45 days does not
begin until the health care plan provider receives the claim, which may delay payment.
Requires physicians to submit a claim to an insurer in a timely manner.
Establishes procedures for a physician to submit a claim to an insurer.
Requires an insurer to make a determination concerning the validity of the claim within 45 days of the
claims receipt.
Sets forth timeframes for requesting additional information concerning the validity of a physician’s claim.
Sets forth procedures for preauthorization and responding to a physician’s request for payment.
Guidelines for Health Plans - H.B. 1913
by Representative Capelo
Senate Sponsor: Senator Shapleigh
Health plans require designations of preferred provider organizations (PPO) or health maintenance
organizations (HMO) to provide due process through the use of an advisory panel of physicians selected by
either health plan. Decisions made by the panel are advisory only, and a provider who brings a case
before the panel may still be deselected from the health plan without good cause. Providers may seek
legal redress, but due to time constraints or cost considerations may be unable to prevail in their litigation.
Requires certain federal guidelines regarding good faith professional review activities to be met if a
contributing cause of the termination of a contract was based on utilization review, quality review, or any
action reported to the National Practitioner Data Bank. Authorizes aggrieved parties to bring an action for
failure to follow procedures.
An Actuarial Evaluation of Life Insurance Policies - H.B. 2415
by Representative Giddings, et al.
Senate Sponsor: Senator Ellis
Requires the commissioner of the Texas Department of Insurance to conduct a marketplace study by
evaluating the relevant actuarial and expense relationships between the cost of small face amount policies
and the benefits received.
Health Maintenance Organizations and Consumer Choices - H.B. 2430
by Representative Naishtat, et al.
Senate Sponsor: Senator Carona
Creates a consumer assistance program to provide information to all health insurance consumers.
Senate Research Center 177