Getting Stiffed No Longer Needs to be a Cost of Doing Business: Texas Prompt Pay Provisions (Medicolegal Issues)
Despite the enactment of new “prompt pay” legislation in 2003, many health care providers still accept slow, low, or no reimbursement from a health maintenance organization (HMO) or preferred provider organizations (PPO) for their services. Some health care providers do so because they have been conditioned to accept this behavior as a cost of doing business. Others are fearful of retaliation by the HMO or PPO if they press for what they are entitled to. Texas law and the current posture of the Texas Board of Insurance are such that Texas health care providers no longer have to accept this mistreatment as a cost of doing business. In this regard, Texas’s current prompt pay statute is arguably one of the most provider-friendly statutes in the country considering the penalties and protections offered. Current Texas prompt pay provisions come from two legislative enactments: House Bill (HB) 610, passed in 1999, and Senate Bill (SB) 418, passed in 2003. These provisions have been codified in Article 3.70-3C and Chapter 843 of the Texas Insurance Code. In addition, applicable provisions are set forth in the Texas Administrative Code (1).