SB 481

84(R) - 2015
Senate Business & Commerce
Senate Business & Commerce

Vote Recommendation

  • Neutral
  • Positive
  • Neutral
  • Neutral
  • Positive


Kelly Hancock

Bill Caption

Relating to notice and availability of mediation for balance billing by a facility-based physician.

Fiscal Notes

Estimated Two-year Net Impact to General Revenue Related Funds for SB481, As Introduced: a negative impact of ($124,258) through the biennium ending August 31, 2017.

The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement the provisions of the bill.

Bill Analysis

SB 481 would make three changes to the health insurance laws. Firstly, it would change the meaning of “facility-based physician” by including an assistant surgeon. The purpose of this is to expand health insurance coverage that an assistant surgeon provides.    

Secondly, the bill would require a physician who works at a health facility, but is not on that facility’s health network, to send a patient a billing statement that clearly explains a mandatory mediation process for medical expenses charged by the physician. This is required of physicians who are not part of a patient’s preferred provider benefit plan or health benefit plan.

Thirdly, and most importantly, SB 481 would remove the $1,000 threshold for when a patient may request mediation for balance billing issues. 

Vote Recommendation Notes

5/13/2015 Update:

We preferred the Senate version of this legislation which would have removed the threshold to challenge altogether. The House committee substitute would reinstate the threshold but reduce it to $500 from the $1000 as is current law. While we preferred the Senate approach this is still a beneficial bill that takes a step in the right direction and we continue to support it.

The second chamber sponsor is Rep. Sheets.

Original First Chamber Analysis Below: 

Balance billing occurs when a physician bills a patient for medical expenses that the patient’s insurance plan does not cover. The practice of balance billing should be abolished because a patient has no control over who works on them when they are at a hospital. This issue is especially prevalent during emergency room visits. Moreover, it is very difficult for a patient to find out how much a service would cost for an out-of-network provider. Unfortunately, this means a patient is charged additional medical expenses because, unbeknownst to the patient, a physician or service is not covered under his or her insurance plan.

Currently, mediating balance bills are eligible if they are over $1,000. Fortunately, SB 481 takes a step in the right direction by removing the $1,000 threshold. This would allow a patient to dispute a balance bill of any amount.

For these reasons, we support SB 481 because it protects an individual’s private property rights by allowing them to dispute the charges of an unfair billing practice. Overregulation of the health insurance industry has caused this issue to come into existence. If the free market was allowed to operate in the healthcare industry, this arbitrary billing practice would result in medical care facilities or physicians losing business.    

Organizations Supporting

Texas Association of Business
Texas Association of Health Plans