August 05, 2020

Texas Department of Insurance Issues Preliminary Report on IDR Process

Earlier in 2020, the Texas legislature passed out-of-network billing legislation “Texas Arbitration Process” (SB 1264) modifying its existing statute. Although the SB 1264 prohibits balance billing by out-of-network providers, the measure includes a robust Independent Dispute Resolution (IDR) process as well as a biennial data reporting requirement. Although the first report is not due until December 2020, the Texas Department of Insurance (TDI) issued a six-month preliminary report on SB 1264 as an early indication of how the system is working.

Although there remains a question on whether COVID-19 environment has had an impact on the number of claims, the preliminary findings seem to indicate that the law is working as intended. As of June 30, 2020, TDI noted that it has received more than 9,000 requests for dispute resolution under the new process, provider complaints about billing disputes have decreased more than 70% from the same period a year ago and consumer complaints about balance billing have fallen by more than 95%.