Texas insurance regulators can require health plans to disclose their policies for paying doctors and hospitals, state Attorney General John Cornyn said in an opinion that carries the force of law unless overridden by the Texas Legislature. The state insurance department had declined to issue rules requiring insurers to disclose reimbursement information to providers, saying it believed it lacked the authority. Cornyn was responding to a request by a supporter of such rules to clarify the state’s 1999 prompt-payment law, which requires health plans to pay proper claims within 45 days or face fines. The Texas Medical Association contends that rules requiring mandatory disclosure are necessary because health plans have unfairly delayed, denied or reduced reimbursement. The Texas Association of Health Plans said in a written statement that it believes releasing information such as coding guidelines and fee schedules will increase healthcare costs.
In other Texas insurance news, the state insurance department placed AmCare Health Plans, Houston, on its “watch list,” meaning it will monitor the Medicare HMO’s reserves and claims payments. AmCare has been struggling financially partly because an affiliate is 90 days past due on an $18 million payment. The 44,000-member plan posted a net loss of $6.2 million in the fourth quarter of 2001. AmCare officials say the HMO does not have the financial reserves the insurance department requires and must come up with a plan to return to financial stability.