Texas advocacy, business, insurer, and public policy groups are teaming up to help fix surprise medical bills. These bills, also known as balance billing, often occur in emergency situations when a patient visits an emergency room and is unable to choose all the doctors they see, resulting in out-of-network care even for an in-network hospital. The resulting bill can be much larger than expected, and there have been moves made in the Texas Legislature to create a mediation system that helps providers and health plans to come together and figure out a fair payment.
Despite the current mediation process, which exists thanks to local lawmaker Kelly Hancock, surprise bills are still relatively rampant in Texas, particularly in the emergency room. One in three visits to the emergency room in Texas result in a surprise bill, while nationally the rate is one in five. 300 of 407 Texas hospitals have no physician in the three major health plans’ networks. Freestanding emergency rooms, which have proliferated in Texas since a law was passed to allow them, account for 83 percent of surprise medical bills. Half of all ER claims are out of network in Texas.
The mediation process that is in place isn’t often used. According to the Texas Department of Insurance, fewer than 10,000 of the 250,000 surprise medical bills sent to Texans every two years go into mediation. But when it is used, it has a significant impact on consumers’ pocket books, as 11,000 Texans have saved $25 million since 2015, an average of $2,203 per bill.
A Kaiser Health News story details several Texans who were left with more than $50,000 bills after trips to the emergency room where they received care out-of-network, including a patient who purchased health insurance from Baylor Scott and White Health through the healthcare exchange. Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities in Austin, described how difficult and confusing it can be for patients to trigger the mediation process.
The Kaiser story details how other states have taken the patient out of the process, creating systems where they never even see the bill. In Texas, the patient must initiate the mediation process.
In a joint statement released by the Texas Association of Health Plans, several groups condemned the practice. They said patients “should not receive additional surprise out-of-network charges when they have no ability to ensure their care is in-network.”
The groups have agreed on a number of statements toward that end.
- Everyone in Texas deserves affordable, high-quality coverage and care, and control over their health care choices.
- Patients Should be Protected from Surprise Medical Bills.
- Patients should not be financially penalized in cases when they receive out-of-network care through no fault of their own.
- Health Care Providers Should be Fairly Compensated.
- State Policy Should Restrain Costs and Ensure Quality Networks.
- Patients Should Be Informed When Care Is Out of Network.
“We still see it over and over again in the news—Texans constantly receive outrageously-high surprise medical bills for health care they receive in an emergency,” said TAHP CEO Jamie Dudensing via release. “We are committed to working with the legislature this session to put an end to surprise billing and make sure patients are no longer held hostage during these billing disputes.”
The organizations who signed onto the statement include the AARP, Texas Texas Association of Business, Center for Public Policy Priorities, Texas Association of Health Plans, National Federation of Independent Business, Texas Association of Life & Health Insurers, National Multiple Sclerosis Society, and the Texas Association of Health Underwriters.