Texas Commissioner Warns HMOs, Insurers About Slow Payments

Texas Department of Insurance Commissioner José Montemayor issued a bulletin on May 21 warning HMOs and health insurance companies that they risk disciplinary actions if they violate state laws concerning prompt payment to health care providers. Montemayor said TDI intends to enforce laws and rules directing companies with preferred provider plans to pay “clean claims” within the required 45 days after receipt of those claims. Last year, the department issued its specifications for what constitutes a “clean” claim. The commissioner’s bulletin also reminded HMOs and insurance companies of various other requirements concerning prompt payment of claims. TDI reported that the agency received over 10,000 provider complaints alleging slow payment by insuring entities last year. About half of those complaints were found to be justified.