Covered Entities

The Texas Prompt Pay Act provides crucial legal protection for doctors and other medical service providers when it comes to getting the money they are owed. Because many insurance companies act in ways that are intended to limit the payments they must make to doctors to the fullest possible extent, the Prompt Pay Act provides a legal mechanism by which medical professionals can take action to get the compensation they are due in a timely manner.

However, not all insurance programs are covered under the terms of the Texas Prompt Pay Act, making it essential that doctors be able to differentiate between covered and non-covered entities in order to be able to fully uphold their rights under the law. If you are considering pursuing a Prompt Pay claim, the attorneys of Williams Kherkher understand how important it may be to your practice and can help you understand your options.

Covered and Exempted Entities

The Texas Prompt Pay Act only applies to health maintenance organizations (HMOs) and preferred provider organizations (PPOs), as well as a few other select groups. Those groups that are exempted from the Act include:

  • Medicare
  • Medicaid
  • Self-funded ERISA plans
  • Health Select and Health Select Plus plans
  • Federal employee plans
  • Self-funded University of Texas and Texas A&M University employee plans
  • TriCare
  • Texas Association of School Board coverages
  • CHIP
  • Workers’ Compensation

Medical care providers cannot pursue a Prompt Pay claim against these types of plans.

Contact a Prompt Pay Attorney in Texas

If you are a medical service provider who is experiencing difficulties receiving the full amount of compensation that you may be owed, our legal team at Williams Kherkher may be able to help you fight for the payment you are seeking. Get in touch with us today at (888) 220-0640 and learn more about both your eligibility for filing a claim and how we can provide much-needed legal guidance.

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