Limiting Surprise Medical Bills

CPPP's Stacey Pogue

No one likes an unexpected bill, but Texans are fed up with the surprise bills they receive after ER visits, even when they go to hospitals in their insurance network. This session the Legislature is listening to them.

Michael Fryar from Grapevine went to an in-network ER for appendicitis, and later got a surprise bill of more than $700 from an imaging consultant he’d never even seen. Jennifer Hopper from Austin took her husband to an in-network ER when he was hit in the face with a baseball. They got a surprise bill of nearly $800 from an out-of-network ER doctor. Both Michael and Jennifer gave compelling testimony about their situations to the House Committee on Insurance last week on two bills that would help Texans who receive out-of-network surprise medical bills.

There’s no guarantee if you go to a hospital in your health insurance network that the care you’ll get–like ER doctors, anesthesiology, labs or X-rays–will also be covered as in-network. This leaves too many Texans susceptible to hefty, surprise out-of-network medical bills, even though they were careful to go to an in-network hospital. And attempts to dispute the charges often mean another nasty surprise–Texas law prohibits residents from getting help resolving these surprise medical charges unless the bill is more than $1,000.

This session the Legislature is making progress on meaningful consumer protections, and last week was a big week at the capitol for legislation related to curbing surprise medical bills.

On Thursday the Senate passed SB 481 by Senator Kelly Hancock, which would give mediation rights to all Texans who go into an in-network hospital but who leave with out-of-network bills. Today, mediation to address these bills is only available to people with a surprise bill that tops $1,000.

In addition, the House Insurance Committee took up surprise bills on Wednesday night. They heard two bills by Representative John Smithee, HB 3133 and HB 1638, which work together to plug loopholes in the existing mediation system.

HB 3133 is the companion to SB 481 mentioned above, and gets rid of the arbitrary $1,000 threshold that keeps too many consumers from accessing help through mediation.

HB 1638 has an additional layer of protections that will just apply in emergencies, when consumers are unable to choose the doctors who treat them or ensure they are in-network. HB 1638 prevents consumers who went to an in-network emergency room from being caught in the middle of any out-of-network billing disputes between insurers and doctors. Doctors want payments to be high and insurers want to keep them low, but right now the burden falls on the patient to request mediation. HB 1638 fixes that.

Today too many Texans have medical emergencies followed by financial emergencies due to surprise bills, but bills moving this session can curb this practice and help protect Texas consumers.

Our report on surprise ER billing, Surprise Medical Bills Take Advantage of Texans, offers a detailed analysis of how out-of-billing from in-network emergency rooms is taking a toll on Texans.

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