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Texas Warns Carriers On Provider Fee Disclosure

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NU Online News Service, April 14, 2004, 5:55 p.m. EDT – Texas insurance regulators want health carriers in their state to give doctors more detailed information about fees and fee changes.[@@]

State-regulated carriers must give doctors and other providers access to a Web site that provides specific code and fee information or to some other equivalent resource, regulators say.

Texas regulators warn that simply sending providers the address of a general Web site is “not sufficient.”

Carriers must send providers “specific directions about how to access the information,” according to Kimberly Stokes, the senior associate commissioner for life, health and licensing at the Texas Department of Insurance.

Stokes describes the fee information disclosure requirements in Texas Insurance Commissioner’s Bulletin Number B-0017-04.

The Texas department adopted rules in September 2002 that implement a law that requires health maintenance organizations and insurers that use preferred provider networks to offer providers access to detailed fee schedules.

The rules also requires carriers to notify providers 60 days before making fee changes. In September 2003, the Texas department amended the rules to reflect a new law that requires carriers to give providers 90 days’ notice about fee changes.

“It has recently come to TDI’s attention that some carriers are notifying their contracted physicians and providers of fee schedule changes by providing a representative sample of the new fees,” Stokes writes in the bulletin. “While specific codes and fees listed in a representative sample would comply with the notice requirement if applicable to the notice recipient, the sample would not satisfy the requirements of the rules regarding those fee changes not illustrated in the sample.”

The Texas department has posted the bulletin on the Web at