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Texas Legislature Passes Patient Protections for Freestanding ER Price-Gouging, Deceptive Practices

Friday, May 24, 2019  
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May 24, 2019

John Ford, jford@tahp.org

 

 

Texas Legislature Passes Patient Protections for Freestanding ER Price-Gouging, Deceptive Practices

Freestanding ERs are responsible for more than $3 billion in unnecessary health care costs each year in Texas

AUSTIN The Texas Legislature sent sweeping legislation to Gov. Greg Abbott today that will protect Texas patients from price-gouging, deceptive practices and misleading information at bad-acting freestanding emergency rooms (FSERs).

FSERs—facilities that charge emergency care prices but usually look like urgent care centers and tend to attract patients seeking treatment for minor conditions—are a relatively new, lucrative business model that leave Texas patients with sticker shock from outlandishly expensive medical bills. FSERs are responsible for more than $3 billion in unnecessary health care costs in Texas every year. Because FSERs are rarely in network with patients’ health plans, they can charge outrageously high prices for services and surprise bill patients for whatever amount remains after the health plan’s payment. One Texan recently received an astronomical $71,000 total bill from an FSER for eight stitches. These unnecessary high prices and surprise bills drive up health care costs and insurance premiums for all Texans.

“When a patient seeks emergency medical care from a Texas freestanding ER, they are looking for a lifeline during one of the most vulnerable moments of their life. Instead, many freestanding ERs are providing a financial setup,” said Texas Association of Health Plans CEO and registered nurse Jamie Dudensing. “These facilities have demonstrated a clear pattern of withholding important information or lying to patients regarding their network status, then price-gouging them for astronomical amounts after providing care. We applaud the Texas Legislature for holding freestanding ERs accountable and equipping consumers with the information they need to make better decisions for themselves and their families.”

HB 1941 by Rep. Dade Phelan, R-Beaumont, will protect Texans against this type of price-gouging in emergency care situations at FSERs. The bill grants the Texas Attorney General the power to take action against FSERs that charge consumers more than 200% of average charges for emergency care in the area, similar to process the AG uses to protect Texans from-price gouging during a natural disaster.

HB 2041 by Rep. Tom Oliverson, R-Cypress, will protect Texas consumers and help lower health care costs by requiringTexasFSERs to be transparent about their prices and network status. The bill requires FSERs to provide their prices to patients in a new written disclosure at the time of service or on their website. The bill also puts an end to the misleading language and deceptive practices that confuse consumers about the network status of FSERs. HB 2041 prohibits these facilities from using phrases like “we take” or “accept” all insurance unless they are in network with insurers and prohibits the display of a health plan’s logo or name if the facility is not in network with that plan.

According to a recent AARP investigation, 77% of FSERs use confusing language such as stating they “take” or “accept” insurance when they are out of network for any major health plan, nearly 30% claimed they were in Blue Cross and Blue Shield of Texas’ network when they were not, and 30% of FSER websites do not comply with state network transparency laws.

“By holding freestanding ERs more accountable, consumers will be better equipped to make informed decisions and protect themselves and their families,” said Dudensing.

Resources:

  • To view TAHP’s one-pager on HB 1941, click here.
  • To view TAHP’s one-pager on HB 2041, click here.
  • To view TAHP’s one-pager on Texas freestanding ERs, click here.
  • To view AARP’s investigation, click here.
  • To view TAHP’s findings from its out-of-network claims survey, click here.
  • To view an example of an outrageous FSER bill, click here.

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The Texas Association of Health Plans

The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.


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