Dive Brief:
- The Texas Association of Health Plans and the Texas Medical Association have taken the argument over "balance billing" public via heated statements that blame each other for the issue.
- Balance billing, or surprise medical bills, occur when a patient receives care from an out-of-network provider at an in-network facility, often when they are unaware or lack reasonable alternatives.
- The issue has been gaining attention this year and resulted in legislative action in Texas, where lawmakers passed Senate Bill 481 to extend a mediation process to patients facing a balance bill of at least $500, down from the previously required amount of $1,000.
Dive Insight:
The issue between Texas providers, insurers and hospitals is now out in the light, where it may receive much needed attention but also criticism from advocates who argue patients remain caught in the middle.
It began when The Texas Association of Health Plans suggested doctors were inflating charges to make more money, referencing a study by America's Health Insurance Plans, which found Texas ER physicians were charging out-of-network patients a rate more than six times higher than what Medicare pays.
The Texas Medical Association retorted other studies show 73% of Texas insurance networks to be "small," suggesting insurers are purposely offering unreasonable in-network rates to doctors to save money.
Whoever is to blame, the issue is real; a 2014 report by the Center for Public Policy Priorities found nearly two dozen Texas hospitals do not have any ER doctors in-network for the state's three top health insurers.
Advocates say the blame is shared and call for interest groups to work together on a solution.