Rep. Greg Bonnen
Rep. Greg Bonnen (R-League City) has filed legislation to block health maintenance organizations (HMOs) and health insurers from terminating or penalizing preferred providers or insureds for the use of out-of-network providers to address a patient’s health care needs. HB 574 prohibits an HMO from terminating participation of a health care provider in a preferred provider benefit plan solely because (1) the provider informs an enrollee of the full range of available providers, including out-of-network providers, (2) the provider’s patients utilize out-of-network providers, or (3) the provider communicates with an insured regarding the availability of out-of-network providers. Similarly, the bill bars an HMO or health insurer from terminating or penalizing an insured solely because the insured uses an out-of-network provider.
Finally, HB 574 requires an insurer seeking to terminate participation of a preferred provider to provide an expedited review that complies with applicable TDI rules, as well as all information on which the insurer used to make the determination, including the economic profile of the provider, the standards by which the provider is measured, and the statistics underlying the profile and standards.
