For patients visiting emergency rooms in Texas, surprise medical bills are common. In 2009, the Texas Legislature developed a mediation system for these hefty bills, but it was limited.
Gov. Greg Abbott has signed a new law aimed at improving the system and expanding consumer protection.
'A flip of the coin'
Here’s what happens: There’s a medical emergency — a fall, a really bad asthma attack — and you rush to the hospital. Perhaps you’ve even taken the time to make sure it’s a hospital in your insurance network. A few weeks later, you get home and, surprise: a medical bill big enough to give you a heart attack.
Stacey Pogue, senior policy analyst at the Austin-based Center for Public Policy Priorities, says surprise medical billing is especially common in an emergency.
“It’s essentially a flip of the coin when you get treated in an emergency room by a doctor whether your treatment will be in network or out of network,” Pogue says. “So it’s happening to patients all across the state.”
Surprise medical bills, which are also called “balance bills,” happen when insurers and doctors fighting over prices jointly pass the buck to a patient who received the out-of-network care unknowingly.
In 2009, the Texas legislature established a system to help Texans challenge these surprise medical bills, but Pogue says hardly anyone knew about it, and many weren’t eligible. The bill that passed this session will make what’s called “mediation” accessible to more people.
“What happens is once the consumer asks for help, the insurance company and the doctor have to pick up the phone and talk about the price,” Pogue says. “They work it out more than 90 percent of the time, and the consumer saves money — hundreds or thousands of dollars.”
The new law covers medical bills from more healthcare providers, including freestanding emergency rooms, and requires both health care providers and your insurance company to tell you about mediation using standard, clear language that’s easier to understand.
Pogue says Texas is now one of a handful of states to pass a balance billing law to protect consumers against surprise medical bills.
“There are a handful of states, among them Florida, California, Illinois, that have solved the problem in a far more comprehensive way for consumers,” Pogue says. “In those states you don’t get hit with a surprise bill at all. It’s worked out: The fight between doctor and insurer happens behind the scenes, you don’t have to get the bill, know about mediation, ask for help and navigate a complicated process.
"But there’s a whole bunch of states that haven’t done nearly as much as Texas has.”