AUSTIN—The Texas Association of Health Plans (TAHP) expressed support today for landmark legislation filed by State Sen. Kelly Hancock, R-North Richland Hills, and Rep. Trey Martinez Fischer, D-San Antonio, that would prohibit health care providers from sending patients surprise balance bills in situations in which patients have no real choice of provider, such as when a patient receives care from an out-of-network doctor at an in-network hospital ER during an emergency.
When patients do not pick their provider or are misled about a provider’s network status, care is too often followed by expensive and unexpected surprise medical bills, often for thousands of dollars and sometimes for hundreds of thousands of dollars. Texas leaders have taken steps over the past decade to create protections from surprise medical bills, but problems remain in Texas—particularly in the ER.
It is nearly impossible for Texans to stay in-network during an emergency, even when they go to an in-network hospital. In fact, more than 65 percent of all out-of-network ER doctor claims in Texas are for services provided at a network hospital, and 300 of Texas’ 407 hospitals have no in-network ER doctors for the three major health plans.
“Texas has some of the most expensive ER costs and highest rates of surprise billing in the country, and Texas patients are paying the price,” said Jamie Dudensing, TAHP CEO and a former practicing nurse. “Sen. Hancock and Rep. Martinez Fischer have filed landmark legislation that will end surprise billing and help protect Texas patients from medical debt once and for all. Sen. Hancock and Rep. Martinez Fischer have been leaders on this issue for a decade, and we commend them for their important work.”
Texas patients should never be financially penalized when they receive care from an out-of-network provider they did not choose, especially in an emergency. Instead, health plans, doctors, hospitals and freestanding ERs should be held responsible for the billing disputes for these remaining costs, for initiating mediation and for using Texas’ system to reach an agreement on price.
The legislation would:
- Prohibit out-of-network providers from sending surprise bills when the patient does not have a real choice of provider.
- Make patients responsible only for their applicable co-pays, coinsurance and deductibles amounts with no additional amounts due resulting from mediation between the out-of-network provider and health plan.
- Require health plans to pay reasonable or agreed-to amounts to out-of-network emergency care and facility-based providers and allow those providers to dispute payment amounts through binding mediation.
- Protect patients’ credit by prohibiting the issuance of a consumer report of medical debt resulting from balance billing by an out-of-network facility-based provider at a network hospital or an emergency care provider if the patient had health coverage.
To view TAHP’s new report on Texas’ out-of-network emergency care crisis, click here.
To view TAHP’s press release on its out-of-network emergency care crisis report, click here.
To view TAHP’s fact sheet on this legislation, click here.
To view TAHP’s fact sheet on surprise billing in Texas, click here.