The Texas HMO Act requires all contracts between an HMO and physicians or providers to hold enrollees harmless for payment in the event an HMO fails to pay the physician or provider for health care services. In recent Opinion No. GA-0040, the Texas Office of the Attorney General determined that the Texas HMO Act's hold harmless provisions do not exist absent a contract and do not, therefore, prohibit physicians who are not under contract with an HMO from balance billing an HMO's enrollee for charges not paid by the HMO. However, the scope of the AG Opinion expressly excludes whether or not state law permits a network facility to require non-network physicians with privileges at the facility to honor the facility's hold harmless agreement with the HMO.
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