Hopeful Legislation Could Help Address Our Texas-Sized Surprise Medical Billing Problem

Surprise medical bills happen when insurers and doctors or other health care providers – fighting over prices – jointly pass the buck to a patient, who received out-of-network health care unknowingly. Texas technically has a “mediation” system for surprise medical bills but the hurdles patients must overcome just to get in the door, prevent most from getting help.
Senate Bill 507 sponsored by Senator Hancock and House Bill 1566 sponsored by Representative Frullo will help ensure more Texans with surprise medical bills can benefit from mediation
Recent studies should put even more urgency behind ongoing legislative efforts to better protect Texas patients from surprise medical bills.
We already knew that surprise medical billing occurs far too often in Texas, especially to patients who have had a medical emergency. A recently released CPPP report finds more than 300 Texas hospitals where the hospital itself is in-network, but there is not a single in-network emergency room doctor available with at least one of three large insurers examined in the study.

Proportion of ED Visits at In-Network Facilities Involving Out-of-Network Physicians, by Hospital Referral Region. Courtesy of http://catalyst.nejm.org/out-of-network-physicians-emergency-billing/

But until recently, we didn’t know how Texas compares to other states. Two recent reports show how states stack up on surprise bills, and they have bad news for Texas patients. Both reports show that surprise bills stemming from emergencies are more common in Texas than most other states.
A study published in Health Affairs in December found that, nationally, 20 percent of patients admitted to the hospitals through the emergency room were likely to get a surprise medical bill. In Texas, the rate is much higher—34 percent. In fact, Texas was one of only five states with rates at or above 30 percent (the others were Alaska, Florida, New Jersey, and New York).
The same study also looked at the likelihood of a surprise bill following an outpatient ER trip (as opposed to one that required a hospital admission, above), and Texas topped the charts here too. Nationally, 14 percent of outpatient ER visits were likely to result in a surprise bill, and in Texas it was 27 percent. Texas is one of just 4 states where the rate was 20 percent of higher (the other states were Alaska, Florida, and New York).

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