The Texas Prompt Pay Act (the “Act”) requires healthcare insurers to make coverage determinations and pay claims within a specified time or face penalties. The parent of Blue Cross Blue Shield of Texas (“BCBSTX”) challenged, in part, whether the Act would apply to self-funded plans in which BCBSTX acts as the third-party administrator. The federal district court held that the Act does not apply to self-funded plan administrators. The U.S. Court of Appeals for the Fifth Circuit upheld the decision.
The court’s opinion in Health Care Service Corp. v. Methodist Hosp. of Dallas, No.15-10154 (5th Cir. Feb. 10, 2016) is available here.