Cash Pay Centric Health Plans are becoming a growing market trend, catching the attention of plan sponsors and government officials. The strategy is based on common sense, reason and logic applied to health care, something long missing from American health care financing.
Texas Senate Bill 583, introduced this legislative session, addresses cash pay claim transactions for health care services, codifying cash payment for services in lieu of insurance based claim payment. If passed health plans would be required to credit an insured’s cash payment for covered services towards their out-of-pocket maximum.
| CLAIM FOR | ||
| BENEFITS; EFFECT ON PLAN. (a) A health care provider may not be | ||
| prohibited from accepting directly from an enrollee full payment | ||
| for a health care service in lieu of submitting a claim to the | ||
| enrollee’s health benefit plan. | ||
| (b) Notwithstanding Section 552.003 or any other law, a | ||
| health care provider’s discounted cash price for services rendered | ||
| is considered full payment for purposes of Subsection (a). | ||
| (c) A health benefit plan shall apply the charge for a | ||
| health care service for which a health care provider accepts a | ||
| payment described by Subsection (a) from an enrollee towards the | ||
| enrollee’s out-of-pocket maximum if the service is a covered | ||
| service under the plan. Payments for uncovered services are | ||
| ineligible to apply towards an enrollee’s out-of-pocket maximum. | ||
https://capitol.texas.gov/Search/DocViewer.aspx?ID=88RSB005831B&QueryText=Insurance&DocType=B
