Legal Health: State Legislatures Address “Surprise Bills” from Out-of-Network Providers

Houston Medical Times August 2015

Charles C. Dunham, IV, an Associate in the Health Care and Life Sciences practice, in the firm’s Houston and New York offices, authored an article in the Houston Medical Times, titled “Legal Health: State Legislatures Address 'Surprise Bills' from Out-of-Network Providers.”

Following is an excerpt:

One of the underlying causes of these “surprise bills” is MCOs shrinking the provider networks to control and reduce costs. For example, in 2013, UnitedHealthcare terminated more than 2,200 physicians’ participation agreements under its Medicare Advantage plan network in the state of Connecticut. While the majority of states have enacted laws to prohibit wrongful termination of a physician’s participation agreement, such as retaliation for certain protected conduct, there is sometimes no similar protection against the non-renewal of a participation agreement. This past legislative session, the Texas legislature passed an Act amending the statutory protections afforded to physicians and providers participating in certain managed care plans to prohibit wrongful termination or non-renewal of participation agreement based solely on informing the patient of, or the patient using, an out-of-network physician or provider for health care services.