Texas state senator asks governor to sack insurance commish
Texas state Sen. Wendy Davis, D-Fort Worth, is calling on Gov. Rick Perry to replace Insurance Commissioner Eleanor Kitzman, charging that in the year since she was appointed the regulator has “shown a clear pattern of disregard for consumer interests in Texas, indifference to the will of the Texas Legislature, and a bias favoring insurance companies rather than the interests of Texas.”
In an Aug. 30 letter to Perry, Davis – who was elected in 2008 – takes particular issue with a decision by Kitzman to delay and make changes to rules governing health insurers’ balance billing disclosures. In December, Kitzman suspended the rule-making that had been advocated by her predecessor, Mike Geeslin. Davis wrote of the revised rules Kitzman unveiled more recently:
She eliminated well thought out rules that required health insurance companies to make clear information available to policyholders about in-network providers. This rule would have protected consumers from being charged out-of-network fees by giving them important information about their plans. Without this rule, many Texans will be charged hundreds or thousands of dollars more than they expected because the policyholders will be unaware of when a so-called “in-network” provider utilizes or partners with out-of-network services. The proposed rule blocked by Commissioner Kitzman would also unnecessarily prolong the amount of time it takes doctors to be compensated for their services.
Balance billing occurs when a doctor, hospital or other health providers submits an invoice directly to a patient to be compensated for services above and beyond the amounts that were remitted by a health plan (not including any deductibles or co-payments the patient is expected to pay.) It is illegal for health providers to balance bill for Medicare services, and most states have laws that prohibit doctors who have contracts with health plans from seeking reimbursement directly from patients who are members of those plans.
Nonetheless, there are some gaps in the prohibition, particularly for elective services or services that are provided out of network. The Texas rules currently under review would offer enhanced consumer protections and disclosures. But Kitzman has proposed alterations to some of those rules, including abandoning a requirement that insurers disclose holes in their provider networks; striking a requirement that policies spell out which hospitals are “limited” in availability of in-network anethesiologists and other ancillary services doctors and which are “approved”; and permitting insurers to post information about in-network hospital-based doctors to their websites, rather than paying for direct mailings.
The changes were a major focus of discussion of an Aug. 30 hearing of the Senate State Affairs Committee, initially called to focus on the potential to establish an interstate market that would allow Texas consumers to purchase policies sold under other states’ laws. During the hearing, Kitzman defended her department’s approach to the balance billing rules.
“I think that certainly consumers should know up front if there is going to be an out-of-network charge,” Kitzman said at the hearing. “But the process that is in place today doesn’t work well for anyone and I know from personal experience it is almost impossible to find out what a procedure is going to cost up front.”
