AUSTIN, Texas (Nexstar) — The fight over surprise medical bills should be left to providers and health plans rather than the patient, lawmakers at the Texas Capitol say.
Both Sen. Kelly Hancock, R-North Richland Hills, and Rep. Trey Martinez Fischer, D-San Antonio, are working on companion bills that would allow medical providers and facilities to use a Texas Department of Insurance program for balance bill mediations for negotiating payments with health insurance companies. They wouldn’t be able to send surprise balance bills to consumers.
Hancock, who has worked on this issue for a decade, spoke about the current issue for Texas patients during a press conference at the Texas State Capitol Thursday. He helped create a way for patients to fight surprise bills greater than $1,000 for certain-out-of-network providers working at in-network hospitals and facilities back in 2009. Now, after bills to expand the program in 2015 and 2017, the Texas Department of Insurance can help with surprise bills over $500 from emergency providers, including freestanding emergency departments and all out-of-network providers providing services at an in-network facility.
“Still, thousands of Texans receive unexpected and frankly unreasonable surprise medical bills every year,” said Hancock. “Enough is enough.”
Martinez Fischer said a battle between industries is now stressing out patients who need care. “At the end of the day, clinicians want to treat patients. Insurance companies have a responsibility to their shareholders and their policyholders, so why should a patient get caught up in the middle?”
“Here’s how I see it — I’ll be really frank and very blunt. It has been an industry issue for a few years, I grant you that,” said Martinez Fischer. “The health plans and the providers fighting over their businesses and I respect that. But 10 years later, it’s becoming a consumer issue.”
Senate Bill 1264 leaves patients out of the equation in negotiations. It requires health plans, including preferred provider organizations, exclusive provider organizations and health maintenance organizations to pay for emergency care “in an amount that the organization determines is reasonable for the emergency care or at an agreed rate.” Out-of-network providers at an in-network facility and all non-network emergency care providers cannot send surprise bills to patients.
Patients would still be responsible for their co-pay and deductible costs.
“A lot of people are concerned about being stuck with a surprise bill because healthcare is so confusing, so convoluted,” Drew Calver said.
Calver, who is an Austin-based teacher, has a surprise billing story that went nationwide last year. He was billed $108,951 after getting care for a heart attack in 2017. He stood alongside lawmakers when they unveiled this bill in hopes other patients would not be stuck in situations like him. He was able to successfully reach an agreement with the hospital to get the bill down to $332, but recalls the process as stressful.
“It was a huge relief once that bill was taken away, but I should have just been healthy and reducing stress and preventing another heart attack.”
Hancock’s legislation would also apply in situations like Calver’s — federally regulated, self-funded health benefit plans could opt in under this bill and have state protections.
“These plans make up at least 40 percent of the Texas health insurance market,” said Hancock. “It’s our hope that by including these plans in mediation, Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level.”