loser pays the arbitrator in surprise-billing fights

The text as introduced · 229 words

By: Dyson
H.B. No. 5036

A BILL TO BE ENTITLED

AN ACT

Relating to arbitration of certain out-of-network health benefit

claims.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1467.001(6-a), Insurance Code, is

amended to read as follows:

(6-a) "Out-of-network provider" means a diagnostic

imaging provider, emergency care provider, facility-based

provider, or laboratory service provider that is not a

participating provider for a health benefit plan. The term

includes a group of out-of-network providers identified by one of

the following:

(A) a National Provider Identification Number;

(B) a group National Provider Identification

Number;

(C) an Employer Identification Number.

SECTION 2. Section 1467.087(e), Insurance Code, is amended

to read as follows:

(e) The losing party [ parties ] shall [ evenly split and ] pay

the arbitrator's fees and expenses not later than the 30th day after

the date the arbitrator provides the parties with the written

decision.

SECTION 3. The changes in law made by this Act apply only to

a health care or medical service or supply provided on or after

January 1, 2026. A health care or medical services or supply

provided before January 1, 2026, is governed by the law as it

existed immediately before the effective date of this Act, and that

law is continued in effect for that purpose.

SECTION 4. This Act takes effect September 1, 2025.