“This bill is about truth in contracting and shining a light on these silent PPO networks. It’s a great win for medicine to finally get this bill across the finish line.”
buying, selling, or leasing of a contract rate, but it ensures that such activity oc- curs within certain parameters, TMA As- sociate Director for Legislative Affairs Pa- tricia Kolodzey clarified. Prohibiting it al- together was an unlikely scenario, given the growth of so-called rental networks and their entrenchment in the insurance market. But SB 822 does put new regula- tions on those activities. To buy, sell, or lease a contract rate, entities must first:
• Register with TDI; • Give physicians a line-item list of all network products covered by a pay- ment contract and separate, corre- sponding fee schedules; and
• Obtain express authority from and provide prior notification to physi- cians for each line of business.
TDI also has authority to slap finan- cial fines on companies that don’t com- ply or to revoke their licenses to conduct business.
entitled to a particular discount and un- expectedly end up with higher out-of- pocket costs.
The confusion also reflects on physi- cian practices “and undermines our cred- ibility. And as a physician, and especially as a psychiatrist, a big part of that [pa- tient-physician] relationship is trust and credibility,” he said.
Thanks to TMA-won legislation, those
so-called “silent-PPO” activities will no longer fly under the radar. Roughly eight years in the making, Senate Bill 822 — spearheaded by Rep. Craig Eiland (D- Galveston) and carried through by Sen. Charles Schwertner, MD (R-Georgetown) — establishes rules to identify those com- panies, subjects them to oversight by the Texas Department of Insurance (TDI),
and regulates how they share a physi- cian’s contract information. More impor- tantly, it requires a doctor’s permission for the companies to share that informa- tion. The law took effect Sept. 1. “It’s really important the playing field is level,” said TMA Council on Legisla- tion Chair Dawn Buckingham, MD. Dr. Korenman fortunately had a pa- per trail of canceled contracts. Dr. Buck- ingham, however, says her six-physician ophthalmology practice has more than 200 active insurance contracts and thou- sands of claims. “It’s nearly impossible to ferret out which claims are paid correctly and which are not,” she said. “To a prac- tice, this [law] means we are no longer being robbed blind, literally.” The law does not outright prevent the
Rep. Craig Eiland
Sen. Charles Schwertner, MD
42 TEXAS MEDICINE September 2013 Dan McCoy, MD
Dawn Buckingham, MD
“A long time coming” TMA shepherded the bill over the past decade when it helped develop model silent PPO legislation at the American Medical Association that later became the basis for a model bill by the Nation- al Conference of Insurance Legislators (NCOIL). Representative Eiland, a past NCOIL president who worked on the early legislation, carried a version of the bill in Texas over the past three legisla- tive sessions as a vice chair and member of the House Insurance Committee. “It has been a long time coming, but I am happy to say that doctors will now have more transparency in their con- tracts. Transparency was a big theme this session, and I believe is one reason that this issue had more traction than in past sessions. This is more about trans- parency than new regulations,” he said. With the new legislation, “we will be able to know what groups are out there taking doctors’ discounts and where those discounts are coming from. Doc- tors will know exactly what the schedule for each line of business will be and who will have access to those discounts.” Dr. Buckingham added that part of the lengthy process stemmed from the
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