Today the Texas Department of Insurance (TDI) adopted emergency rules
related to “surprise billing.” This Guidance Statement is to provide clear information to Texas patients and professionals under the Texas Medical Board’s (TMB’s) regulatory authority concerning Senate Bill (SB) 1264.
Physicians and practitioners, under the authority and oversight of TMB, who seek to exercise the exceptions to the prohibitions against balance billing must comply with all provisions of SB 1264, including as interpreted by TDI rules.
Specifically, under the Medical Practice Act, violations of SB 1264 and TDI rules include, but are not limited to, violation of state law connected to the practice of medicine and unprofessional conduct.
TMB is a complaint-driven entity and if someone believes a balance billing-related violation occurred they may file a complaint
with the agency. Additionally, TMB and TDI will continue collaborating to ensure that any complaints filed with TDI regarding TMB licensees will be referred to TMB and investigated. All complaints against TMB licensees filed for violating the new balance billing law, regardless of the source of the complaint, will be thoroughly investigated by TMB.
TMB will work on development of rules consistent with TDI’s rules. The Board looks forward to continuing its practice of involving the public and stakeholders on this important issue as the rulemaking process goes forward.