§ 566.051 — LIMITATIONS ON BILLING; NOTICE.

Texas § 566.051

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 566.051. LIMITATIONS ON BILLING; NOTICE. (a) A nonparticipating supplier may not charge an enrollee more than 115 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare for which the supplier has not accepted written assignment unless:
(1) before the enrollee is billed, the enrollee agrees in writing to pay the additional amount; and
(2) before receiving the durable medical equipment, orthotic device or supply, or prosthetic device or supply, the enrollee:
(A) enters into a rental payment plan; or
(B) pays the additional amount in full.
(b) A written agreement between a nonparticipating supplier and enrollee under this section must provide notice to the enrollee that:
(1) Medicare will reimburse 80 percent of the Medicare-approved amount for durable medical equipment, orthotic devices or supplies, or prosthetic devices or supplies covered under Medicare; and
(2) a Medicare supplement benefit plan issuer is not required to reimburse the nonparticipating supplier or enrollee for the amount by which the charge exceeds 115 percent of the Medicare-approved amount.
SUBCHAPTER C. ENFORCEMENT

Legislative History

Added by Acts 2025, 89th Leg., R.S., Ch. 1003 (S.B. 1330 ), Sec. 1, eff. September 1, 2025.