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Texas Legislature makes strides to protect Texans from surprise billing

Friday, June 30, 2017  
Posted by: Jamie Dudensing
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Special to the Star-Telegram

The recent Texas legislative session yielded a number of important patient protections specifically related to medical bills stemming from emergency room and freestanding ER visits. 

Independent freestanding ERs are new, lucrative business models that have popped up at record speed across Texas — often creating confusing and exorbitant medical bills for Texas patients. In fact, with over 200 and counting, Texas has more than half of the total population of freestanding ERs in the United States.

These facilities often look like an urgent care facility, but they never charge like one. Patients should be wary: Freestanding ERs often bill thousands of dollars for common conditions such as sore throats, fever or bronchitis. 

As the number of facilities has grown, so have complaints about them.

Surprise billing, which occurs when a patient unknowingly receives out-of-network care, happens at an enormously high rate in Texas. The likelihood of surprise billing is even higher at freestanding ERs. Nearly 70 percent of out-of-network emergency claims in Texas occur at freestanding ERs and, up until this legislative session, patients had minimal resources to contest these exorbitant medical bills.

Fortunately, Senate Bill 507 by Sen. Kelly Hancock and Rep. John Frullo, as signed into law by Gov. Greg Abbott, will ensure that patients have a way to contest these surprise bills.

SB 507 expands the use of mediation protection to all emergency care, including freestanding ERs, which allows consumers to easily contest surprise medical bills. It’s important for Texans to know about this new law, especially as the number of freestanding ERs continues to rise and consumers increasingly visit emergency centers rather than traditional doctors’ offices for routine medical care.

While SB 507 will help thousands of consumers contest surprise medical bills, House Bill 3276 by Rep. Tom Oliverson will do some heavy lifting on the front end to help patients know if these facilities are really in their insurance network or not.

Freestanding ERs often use intentionally misleading advertising to confuse Texans about their network status. They tell Texans they “accept” their insurance but don’t clarify they are not in their network, creating confusion, frustration, and exorbitant out-of-network medical bills.

HB 3276, signed into law by Governor Abbott late last month, requires these facilities to disclose up front which health plan networks they belong to, and the ones they do not. The last thing patients need is to be haggling with someone at a front desk about the facility’s network status. Having clarity about whether a facility and provider is in network up front will help to prevent patients from being hit later on with surprise medical bills.

Texans deserve to have transparency in their healthcare decisions and protections from surprise medical billing. Texans should be grateful to Gov. Abbott, Sen. Hancock, Rep. Frullo and Rep. Oliverson for their recognition of the growing issue of freestanding emergency rooms, and for taking action to protect patients. Texans need to know they have healthcare options.

Do your homework. When seeking routine medical care, it is best to visit a traditional doctor’s office or an urgent care center. Doing so could save you thousands of dollars in medical costs.

But if you absolutely need to visit a freestanding emergency room, make sure the facility is in your health plan’s provider network before you walk in.

If you do end up in an out-of-network situation, be aware of your options to challenge exorbitant surprise medical bills through mediation. It only involves filling out a one-page form on the Texas Department of Insurance website at www.tdi.texas.gov.

This session, the Texas Legislature made important strides to ensure you have these protections.

Jamie Dudensing is the chief executive officer of the Texas Association of Health Plans (TAHP), an advocate for public and private health plans, improving access to quality health care for the uninsured, committed to enhancing consumer choice and affordability of health insurance for all Texans.