Sec. 1271.008. BALANCE BILLING PROHIBITION NOTICE. (a) A health maintenance organization shall provide written notice in accordance with this section in an explanation of benefits provided to the enrollee and the physician or provider in connection with a health care service or supply provided by a non-network physician or provider. The notice must include:
(1) a statement of the billing prohibition under Section 1271.155, 1271.157, or 1271.158, as applicable;
(2) the total amount the physician or provider may bill the enrollee under the enrollee's health benefit plan and an itemization of copayments, coinsurance, deductibles, and other amounts included in that total; and
(3) for an explanation of benefits provided to the physician or provider, information required by commissioner rule advising the physician or provider of the availability of mediation or arbitration, as applicable, under Chapter 1467.
(b) A health maintenance organization shall provide the explanation of benefits with the notice required by this section to a physician or health care provider not later than the date the health maintenance organization makes a payment under Section 1271.155, 1271.157, or 1271.158, as applicable.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.02, eff. September 1, 2019.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges
Subchapter A. General Provisions
Section 1271.001. Applicability of Definitions
Section 1271.002. Right to Evidence of Coverage; Issuance
Section 1271.003. Evidence of Coverage Not Health Insurance Policy
Section 1271.004. Individual Health Care Plan
Section 1271.005. Applicability of Other Law
Section 1271.006. Benefits to Dependent Child and Grandchild