Limitations On Billing; Notice

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