Texas has become unable to determine whether or not the plans are meeting the needs of consumers.
Texas recently implemented a new regulation for health insurance companies that required them to have to submit reports to the state Department of Insurance in order to help to protect consumers against unfairly high medical bills, but many insurers have been ignoring this requirement, so far.
At the same time, officials in the state haven’t done very much to help to improve compliance.
Under the new regulations, insurance companies are supposed to be filing reports which provide details with regards to their health care network adequacy. The records from the Texas insurance department, however, have shown that among the 140 preferred provider plans that are available in the state, only 25 of them have complied with the necessary report for the deadline of April 1. Over the seven months that have followed, those insurers have not faced any penalties, and only 3 additional insurers have submitted their own reports.
Without the reports from the insurance companies, the state has no way of knowing if fair billing is occurring.
Millions of Texans have already purchased health insurance plans, but the state doesn’t have any way of knowing if those policies provide adequate choice of health care providers with respect to the premiums that are being charged to those consumers.
According to the managed care quality assurance office director at the insurance department in Texas, Debra Diaz-Lara, “We can’t verify that (the insurance companies) do, indeed, have an adequate network, and that’s concerning.”
A spokesperson for the department, John Greely, explained that insurers deserve the additional leeway that they have been afforded throughout the first year of the requirements. He explains that this is “a new requirement,” and that “We’re not trying to hold anything hard and fast until we make sure everybody understands the requirements, and the goal here is to get compliance.”
Equally, some of the lawmakers in Texas have said that the fact that the department is unable to collect the reports from the insurance companies is problematic. For instance, State Rep. Trey Martinez Fischer said that it is “a big deal”.