![]() Too many arbitrations means wasting limited health care dollars.This has continued to grow every month since 2020 – from under 700 per month in early 2020 to nearly 12,000 each month in the first part of 2022. ![]() Texas experienced much higher levels of arbitration than what was expected.Some providers are choosing to remain out-of-network and use the arbitration process for seemingly every claim-betting that the arbitration process will land them higher payments because it leans on the physician’s unilaterally set billed charges. The bad news: The state’s dispute resolution process for settling on a final payment for providers is creating opportunities for abuse and overuse. Patients have been protected from more than $1.3 billion in surprise billing disputes.Patient reports of surprise billing were reduced by 98% from the first half of 2019 to the first half of 2022.The good news: The laws have taken patients out of the middle of disputes between providers and health plans. 1, 2022, other insured Texans are protected through the federal No Surprises Act. These protections covered about 20% of Texans who are in state-regulated plans. TDI’s new biennial report on the state’s surprise billing law shows that Texas patients are being protected from surprise billing, but that some physicians groups are misusing the law with overuse of arbitration and excessive billed charges.īackground: In 2019, the Texas Legislature passed SB 1264 protecting patients from surprise medical bills in emergencies and situations where they couldn’t select the provider.
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