Section 1456.004 - Required Disclosure: Facility-Based Physicians(a) If a facility-based physician bills a patient who is covered by a health benefit plan described in Section 1456.002 that does not have a contract with the facility-based physician, the facility-based physician shall send a billing statement that:(1) contains an itemized listing of the services and supplies provided along with the dates the services and supplies were provided;(2) contains a conspicuous, plain-language explanation that: (A) the facility-based physician is not within the health plan provider network; and(B) the health benefit plan has paid a rate, as determined by the health benefit plan, which is below the facility-based physician billed amount;(3) contains a telephone number to call to discuss the statement, provide an explanation of any acronyms, abbreviations, and numbers used on the statement, or discuss any payment issues;(4) contains a statement that the patient may call to discuss alternative payment arrangements;(5) contains a notice that the patient may file complaints with the Texas Medical Board and includes the Texas Medical Board mailing address and complaint telephone number; and(6) for billing statements that total an amount greater than $200, over any applicable copayments or deductibles, states, in plain language, that if the patient finalizes a payment plan agreement within 45 days of receiving the first billing statement and substantially complies with the agreement, the facility-based physician may not furnish adverse information to a consumer reporting agency regarding an amount owed by the patient for the receipt of medical treatment.(b) A patient may be considered by the facility-based physician to be out of substantial compliance with the payment plan agreement if payments are not made in compliance with the agreement for a period of 90 days.(c) Repealed by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 3.03(1), eff. September 1, 2019.Tex. Ins. Code § 1456.004
Amended by Acts 2019, Texas Acts of the 86th Leg.- Regular Session, ch. 1342,Sec. 3.03, eff. 9/1/2019.Amended by Acts 2015, Texas Acts of the 84th Leg. - Regular Session, ch. 467,Sec. 3, eff. 9/1/2015.Amended By Acts 2009, 81st Leg., R.S., Ch. 1290, Sec. 3, eff. 6/19/2009.Added by Acts 2007, 80th Leg., R.S., Ch. 997, Sec. 11, eff. 9/1/2007.