Legal Fund

TSP utilizes a legal fund to continually advocate for pathologists in the state. The following describes results of our efforts in the 84th Legislative Session.

• Improved SB 481 – Lowering the out-of-network (OON) payment threshold for mediation of claims. The original bill would have removed the threshold completely and required access to mediation in all OON payment disputes. Maintaining a monetary threshold was therefore of paramount importance to avoid abuse of this system by health plans. Though maintaining the $1000 threshold of previous regulation was not feasible, TSP took the lead on recommending an alternative to the zero threshold. The bill was signed with a $500 threshold and went into effect on September 1, 2015.
• Opposed HB 1632 – Prohibiting balance billing and requiring access to expensive arbitration on any OON payments. TSP worked with key legislators to ensure that this bill and the senate companion, SB 1562, never made it out of committee for further consideration.
• Supported HB 616 – Creating a system for providers to be paid for OON services based on aggregated claims data instead of an arbitrary and insufficient amount determined by health plans. Because this was a voluntary process, TSP lobbied in favor of the bill, giving OON physicians a reasonable and transparent option to determine “usual and customary” charges. Carriers fought this bill strenuously throughout the session, and it was left pending in committee after receiving an initial hearing. 

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