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Landmark Bill Protecting Patients From Surprise Medical Billing Passes Legislature

Friday, May 24, 2019  
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May 24, 2019

John Ford, jford@tahp.org

 

 

Landmark Bill Protecting Patients From Surprise Medical Billing Passes Legislature

Texas set to have one of the strongest surprise billing protection laws in the country

AUSTIN—Legislation protecting patients from surprise medical bills passed the Texas Legislature today all but guaranteeing Texas will soon have one of the nation’s strongest consumer protection laws against surprise billing.

State Sen. Kelly Hancock, R-North Richland Hills, authored SB 1264, which prohibits health care providers from sending patients surprise 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 ER during an emergency or when they receive care from an out-of-network doctor at an in-network facility.

It is nearly impossible for Texans to stay in-network during an emergency even when they go to an in-network hospital. In fact, over 65% 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 is long overdue for a legislative fix to our surprise billing problem, and I’m glad to see the widespread support for Sen. Hancock’s bill,” said Texas Association of Health Plans CEO and registered nurse Jamie Dudensing. “Texas has some of the most expensive ER costs and highest rates of surprise billing in the country, and this landmark legislation will finally end surprise billing while helping bring down Texas’ overall high cost of health care.”

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.

SB 1264:

  • Ends surprise billing by out-of-network doctors and facilities when patients have little or no choice over who provides their care.
  • Removes patients from the middle of the payment dispute resolution process between health care providers and insurers.
  • Makes 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.
  • Requires 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.
  • Protects consumers and employers from premium increases and high out-of-pocket costs from excessive billing and charges in Texas.

Resources:

  • To view TAHP’s one-pager on SB 1264, click here.
  • To view TAHP’s one-pager on surprise billing in Texas, click here.
  • To view TAHP’s findings from its out-of-network claims survey, 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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