Texas Insurance Code

§ 38.004 — BALANCE BILLING PROHIBITION REPORT

IN § 38.004Title 2. TEXAS DEPARTMENT OF INSURANCE · Part A. ADMINISTRATION OF THE TEXAS DEPARTMENT OF INSURANCE · Ch. 38. DATA COLLECTION AND REPORTS · Art. A. GENERAL PROVISIONS

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(a)The department shall, each biennium, conduct a study on the impacts of S.B. No. 1264, Acts of the 86th Legislature, Regular Session, 2019, on Texas consumers and health coverage in this state, including:

(1)trends in billed amounts for health care or medical services or supplies, especially emergency services, laboratory services, diagnostic imaging services, and facility-based services;

(2)comparison of the total amount spent on out-of-network emergency services, laboratory services, diagnostic imaging services, and facility-based services by calendar year and provider type or physician specialty;

(3)trends and changes in network participation by providers of emergency services, laboratory services, diagnostic imaging services, and facility-based services by provider type or physician specialty, including whether any terminations were initiated by a health benefit plan issuer, administrator, or provider;

(4)trends and changes in the amounts paid to participating providers;

(5)the number of complaints, completed investigations, and disciplinary sanctions for billing by providers of emergency services, laboratory services, diagnostic imaging services, or facility-based services of enrollees for amounts greater than the enrollee's responsibility under an applicable health benefit plan, including applicable copayments, coinsurance, and deductibles;

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