AUSTIN (NEXSTAR) — A bill filed in the Texas Legislature would require freestanding emergency rooms to provide a written disclosure statement to patients prior to providing treatment.
Consumer advocates say the legislation would be another step in further clarifying the difference between a freestanding emergency center and an urgent care facility for patients.
“We’ve been constantly hearing from our membership that they go to these facilities and they often think that they’re urgent care because they look like urgent care, but they’re usually always out-of-network and charge huge prices,” Blake Hutson, associate state director with AARP Texas, said.
Hutson said that confusion often leads patients down a path of expensive medical bills they didn’t expect. Texas has more than 200 of these facilities, according to the Texas Association of Freestanding Emergency Centers.
“That’s the problem,” he said. “These facilities say they accept or take insurance, which usually in healthcare means you’re in network. That’s not what it means in a freestanding ER. They’ve sort of redefined the terms so the state’s going to have to step in and clear up that confusion.”
Sixty-two-year-old Charles White sought care from one of these facilities last year after he fainted and fell. He said providers at the center administered an electrocardigram, even after he told them he already received one from paramedics.
“They did a chest x-ray for some reason, no idea why,” he said. “They did a blood test and for the majority of the time, for almost three hours, I stood in that room with that ice pack on my head with nobody coming in.”
A nurse and doctor briefly stopped by afterwards, he recalls.
“They said they couldn’t find anything wrong and that it was probably a reflex or whatever, then sent me on my way,” he said. “About a week later, I get a bill for $18,000.”
Shortly after, he learned his insurance company denied most of the $18,000, except for $4,000.
“The insurance company paid $2,000 and then they sent me the bill for the other $2,000,” he said.
White is now paying $50 a month towards his bill.
House Bill 2041, filed by State Rep. Tom Oliverson, R-Cypress, would require that a freestanding emergency medical care facility post information explaining the center or physician providing care may be out-of-network in a patient’s health care plan. It would also require that this information be posted at the facility’s entrance, patient treatment rooms, each area where a patient would pay for services and on the home page of the center’s website. The notice could also be on a different page through a hyperlink, as long as it’s titled “Insurance Information” and available for a person to locate from the home page.
AARP of Texas conducted a project over the summer where the organization called all the freestanding emergency centers in the state.
“We asked them if they were in network and what we found is that there is widespread behavior within the industry misrepresenting themselves as in network, or using that confusing accept and take language,” Hutson said.
The disclosure statement from House Bill 2041 would have to list the facility’s observation and facility fees that may result from a patient’s visit, as well as the health benefit plans in which the facility is a network provider or explicitly explain the center is an out-of-network provider for all health plans. Unless a patient needs immediate medical care, the disclosure statement would have to be given to the individual prior to administering services.
“This legislation is also going to prohibit them from using that ‘we accept’ or ‘we take’ language,” Hutson said.
Another bill filed would allow the Texas Attorney General’s office to step in and take action against a freestanding emergency center for “false, misleading or deceptive acts.” The Consumer Protection Division could also take action against one of these facilities for charging “an unconscionable price” for emergency services or other care. The bill defines “an unconscionable price” as an amount that is at least 200 percent over what a regular hospital charges for a similar service.
The Texas Association of Freestanding Emergency Centers, which represents these facilities statewide, says the surprise bills aren’t due to their members. Instead, they cast the blame on insurance companies.
“Unfortunately, the emergency care that Texans rely on in their time of greatest need continues to be threatened by insurance companies hell-bent on profits at the expense of what’s best for patients and their families,” Brad Shields, executive director of TAFEC, said in an emailed statement.
The organization is working with several lawmakers related to insurance coverage and emergency room care, including House Bill 1832, which deals with the prudent layperson standard. In Texas, emergency care must be covered at the in-network benefit level by insurance companies. House Bill 1832 would prevent the use of a utilization review in determining whether a patient’s medical condition required emergency care. Senate Bill 1054 would prevent insurers from encouraging or instructing a patient to not receive healthcare services from a freestanding emergency center.
“As we have seen in other states such as Ohio, Georgia, and Missouri, insurance company overreach is a real threat to everyday citizens who come to find out that the insurance policy they’re paying a lot for every single month doesn’t cover them in the time when they most need it—during a medical emergency,” Shields said. “We are actively working to fix that here in Texas.”
In the meantime, consumer advocates are urging patients to do some background work before seeking care at any facility.
“Ask questions,” Hutson said. “Are you an urgent care facility – make them tell you.”