The Good News: After you, your colleagues, and patients spoke out last month, the Texas Medical Board (TMB) scrappedplans to impose a minimum 10-business-day wait on patients seeking non-emergency care from an out-of-network physician at any hospital or surgery center in the state of Texas.
The Bad News: The Texas Department of Insurance (TDI) stepped in and imposed a similar rule (applicable to out-of-network physicians at in-network facilities), without an opportunity for public input, that went into effect on January 1, 2020.
Because the TDI adopted the rule on an emergency basis, there is now a 30-day comment period underway as it is under consideration for becoming a permanent regulation.
Additional Background: Last year the Texas legislature passed legislation (SB 1264) purporting to address an issue caused by non-payment by insurance companies, which has been mislabeled as a problem of “surprise” medical bills. The real “surprise” is that insurance companies refuse to pay or negotiate the bills. Because of your advocacy, the version of SB 1264 that passed contained a good provision preserving the rights of patients and out-of-network physicians to work together outside of insurance company control.
The TDI is now improperly inserting itself in between doctors and patients by implementing a 10 business-day waiting period for non-emergency out-of-network physician services performed at hospitals and surgery centers that are in-network for a patient, if the patient and physician wish to leave the insurance company out of the middle of their arrangement.
For example: if a patient, enrolled in a health plan regulated by TDI, wishes to contract directly with a surgeon, but utilize insurance coverage for hospital or surgery center fees, the patient would have to sign the TDI-approved waiver form, at least 10-business days before the procedure, in order to privately contract with the surgeon.
Keep in mind that a 10-business-day wait means in most cases at least a 14-day wait and as many as 17 days in situations where holidays add to the delay.
Unelected bureaucrats should not be allowed to force patients to wait for care from physicians of their choice!
Please take a moment now to speak out against this proposal before the comment period ends. The department will consider any written comments on the proposal that are received by the department no later than 5:00 p.m., central time, on February 10, 2020.
Your comments can be submitted by email to [email protected]; or by mail to the Office of the Chief Clerk, MC 112-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.
The Commissioner will also consider written and oral comments on the proposal in a public hearing under Docket No. 2819 at 1:00 p.m. central time, on February 4, 2020, in Room 100 of the William P. Hobby Jr. State Office Building, 333 Guadalupe Street, Austin, Texas. The department requests that parties who plan to speak at the hearing send their written comments (or a summary of their testimony) to [email protected] by noon January 28, to facilitate a meaningful discussion. (Please let AAPS know if you plan to attend the hearing.)
Below is a template message you can copy and paste into a new email message and modify with your own comments. Don’t forget to add your name and city at the bottom. You can see our draft comment here for additional ideas on what you might want to say and to learn about other flaws in the regulation.
(Note: for many email apps, clicking here will open a new message, addressed to the commissioner, with the template text copied in for you.)
Subject Line: Rules delaying medical care are unacceptable
Dear Commissioner Sullivan,
Thank you for the opportunity to submit comments on 28 TAC §§21.4901 – 21.4904.
Requiring a patient to wait at least 10 business days to receive care from an out-of-network physician — on mutually agreeable terms — is potentially dangerous, contrary to the wording and intent of SB 1264, and antithetical to the principles of limited government and protection of individual rights enumerated in the Texas and U.S. Constitutions.
That is why I am writing today urging you, in the strongest terms possible, to remove the waiting period that delays and impedes access to timely care.
Please stand up for the rights of Texas patients by correcting this serious flaw in the rule.
Thank you for speaking out! With your help AAPS has stopped bad policy in the past. It is time for us to fight again and prevent this dangerous plan from being approved.