The bill amends the Texas Insurance Code to clarify the definition of "out-of-network provider" by including specific identifiers such as a National Provider Identification Number, a group National Provider Identification Number, or an Employer Identification Number. This change aims to enhance the identification of out-of-network providers, which include diagnostic imaging providers, emergency care providers, facility-based providers, and laboratory service providers that do not participate in a health benefit plan.

Additionally, the bill modifies the arbitration process for out-of-network health benefit claims by stipulating that the losing party is responsible for paying the arbitrator's fees and expenses within 30 days of receiving the written decision. The changes will take effect for health care services provided on or after January 1, 2026, while services provided before this date will continue to be governed by the previous law. The bill is set to take effect on September 1, 2025.

Statutes affected:
Introduced: Insurance Code 1467.087 (Insurance Code 1467)