Texas health insurance laws seek to protect consumers and ensure responsibility from providers.
Texas health insurance laws work to protect consumers from unfair costs and coverage plans. Although protections also exist for organizations that help pay for health care as well as health care providers, the vulnerability of individual citizens leads law-based initiatives such as workers' compensation, health maintenance organizational regulations and mediation for provider claims. Texas health insurance laws help manage the high costs of being healthy. The laws most beneficial to you are situational, so make sure to seek the help of someone who has a thorough understanding of the law should you require assistance.
Workers' Compensation
Workers' compensation laws protect consumers from injuries that occur while working. Organizations that provide health care must meet certification criteria by the Texas Department of Insurance. Doing so ensures consumer advocacy and high-quality health care within provider networks. In addition to this protection, a consumer has the right to know about his options within the Workers' Compensation Network (WCN). As members of the WCN, employers are responsible for establishing this communication. New employees must be made aware of these protections within three days of being hired. For information concerning workers' compensation, contact your employer's human resources department or email the Texas Department of Insurance at ConsumerProtection@tdi.state.tx.us.
Mediation for Health-Care Disputes
The Texas Department of Insurance establishes mediation for out-of-network expenses as well as exorbitantly high costs. Mediation claims allow consumers to resolve payment disputes without going to court. The program brings together an out-of-network provider with representatives from your health care plan to deliberate over the required payment. During these talks, parties typically reach an agreement over a fair amount for the consumer to pay. This option presents an alternative to a court date, although it does not close court as an option to the consumer if mediation is unsuccessful. If you have a health care claim that could benefit from mediation, contact the Texas Department of Insurance's Consumer Help Line at 800-252-3439.
Health Maintenance Organization
Health maintenance organizations (HMOs) greatly benefit enrollees through lower premiums. HMOs generally offer no deductible payments and low co-payments at the time of a doctor's visit. However, HMOs limit access to doctors and require referrals to specialists. Texas law requires HMOs to pay promptly for medical expenses and to carry a Certificate of Authority issued by the state. Chapter 11 of the Texas Administrative Code dictates all laws pertaining to HMOs. Full text is provided on the secretary of state's website. Questions concerning HMO laws should be emailed to the Texas Department of Insurance at HWCN@tdi.state.tx.us.
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