Today it was announced that since the No Surprises Act went into effect at the beginning of the year, Americans haveavoided more than 2 million surprise bills. The law protects patients from most surprise medical bills and removes them from the middle of negotiations between providers and insurers when it comes to disputes on what should be paid. That’s the good news.
The use of emergency rooms for primary care services is decreasing, thanks to Medicaid managed care. A recent report by the Texas Health and Human Services Commission (HHSC) shows a 15.5% decrease in the number of potentially preventable emergency room visits in Texas Medicaid and CHIP programs. This is great news for both Medicaid members and taxpayers. Utilizing preventative and standard care before conditions become emergencies leads to better health outcomes and to less costly care.
Can driving just a few miles save a patient thousands of dollars? If they’re in the market for health care, the answer is yes. In Dallas, according to a recent article in D Magazine, the cost of a gallbladder removal surgery can range from $5,000 to $35,000. And rarely are prices posted online—even though they’re supposed to be.
Download PDFBy Jessica Lynch As the public health emergency winds down, millions risk losing Medicaid coverage, not because they no longer qualify but because they get caught in the redetermination process once continuous coverage ends. However, one population faces continual risk for interrupted coverage — pregnant Texas women. When a member loses their Medicaid benefits…
Download PDFby Jamie Dudensing and Alicia Pierce A recently announced change to the administration of the Affordable Care Act will expand access to affordable health insurance for an estimated 5 million Americans. In Texas, it could provide options for more than 600,000 of the state’s uninsured. Currently, individuals qualify for subsidies even if they have…
The Texas Department of Insurance is urging health insurers in Texas to loosen restrictions and show flexibility for people who have already sought or may need medical or mental health treatment in coming weeks.
The 85th Legislative Session has come to a close, and the Texas Association of Health Plans is pleased to report on a number of important achievements made possible through comprehensive communications, education, and advocacy strategy carried out in coordination and collaboration with each of our members.
The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today applauded Senate passage of Rep. Tom Oliverson’s HB 3276, which requires independent freestanding emergency rooms in Texas, which are almost all out-of-network for insured Texans, to be more transparent and upfront with patients about their network status. HB 3276 now heads to the Governor for his signature.
HB 1917 (attached) was filed this week by Raymond, Zerwas, and Four Price. The bill extends the sunset date of the state run VDP Medicaid formulary to 2030. Current statute gives MCOs full control of the formulary in 2018. TAHP is strongly opposed to this bill and has begun making visits to share reasons for opposition. See our one-page legislative guide on the benefits and savings that will be achieved by transitioning the formulary to MCO management here.
The Texas Association of Freestanding Emergency Centers (TAFEC) issued a press release this week claiming 3,400 requests for mediations in Texas are complaints and have resulted in $750,000 in payments to providers as a result of underpayment by insurance companies. Here is a link to the report requested by Rep. Workman from TDI. TAFEC failed to mention that these 3,400 mediation requests to challenge surprise bills from providers totaled more than $6 million in billing and the ultimate result is that consumers were protected against more than $5 million in over-billing by providers. It is also important to note that as it stands, consumer mediation protections do not apply to FSERs. TAHP pointed out these discrepancies to the Dallas Morning News this week; stay tuned for a piece running later this week.