A Texas statute requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties……Court finds statute is not applicable to BCBSTX’s activities as administrator of the self-funded plans………..
Text of Fifth Circuit Decision: Administrator of Self-Funded Plans Not Subject to Texas Prompt Payment Law (PDF)
21 pages. “A Texas statute … requires healthcare insurers to make coverage determinations and pay claims made by preferred healthcare providers within a specified time or face penalties…. HCSC is a mutual legal reserve company that operates in Texas as Blue Cross and Blue Shield of Texas … BCBSTX acts as the administrator for employer self-funded plans … [We hold that the Texas statute] is not applicable to BCBSTX’s activities as administrator of the self-funded plans or state government plans[.]” [Health Care Service Corporation v. Methodist Hospitals of Dallas, No. 15-10154 (5th Cir. Feb. 10, 2016)] (U.S. Court of Appeals for the Fifth Circuit)
