Entities	Texas (8)
Topics and Issues	Medical debt (38) Preemption (11)

On Oct. 20, 2020, Tamara L. Cochran-May, the County Attorney for San Patricio County, requested an opinion from the Attorney General regarding the application of Tex. Bus. & Comm. § 20.05 to self-funded health insurance plans.  This section of law has been under legal challenge from CDIA in CDIA v. Paxton.

Cochran-May asked whether the

statutory language “covered by a health benefit plan” include[s] self-funded plans that have implemented a reference base pricing program? Additionally, does Senate Bill 1037 [2019] prohibit collection agencies of hospitals’ in the state of Texas from furnishing to a credit bureau information that would impair the creditworthiness of individuals for any outstanding balance for medical bills other than copayments, deductibles and coinsurance whose employers have adopted a reference base pricing program?

RQ-0385-KP, FILE# ML-48896-20, I.D.# 48896.

In April 2021, Attorney General Paxton replied to the request from Cochran-May.  In response, the Attorney General wrote that “[n]either the Business and Commerce Code nor the Insurance Code specifically address reference-based-pricing plans…Because the applicability of the statute will depend on the particular facts concerning a reference-based program or plan, we cannot answer your question as a matter of law.” The Attorney General added that

A court would likely conclude that subsection 20.05(a)(5) does not apply to a self-funded plan that does not utilize a network of providers. The subsection does not preclude Texas hospitals’ collection agencies from furnishing to a credit bureau information about an individual’s outstanding balance for medical bills when the employer has adopted a reference-based-pricing program that does not utilize a provider network.