Texas law takes aim at surprise billing
A new Texas law that took effect on Sept. 1 requires freestanding emergency rooms (ERs) to notify patients of their insurance networks, in attempt to reduce surprise billing.
Freestanding ERs in Texas are allowed to post the information on their websites, but they must also provide written confirmation to patients.
Co-author of the legislation state Rep. Tom Oliverson said the law will prevent a freestanding ER from deceiving a patient by sending them a higher-than-expected bill because an out-of-network physician participated in the patient's care.
The Center for Public Priorities released a study earlier this year that found surprise billing, also called balance billing, is a problem across the healthcare system. The New York Times also published an article in July about EmCare, an outsourcing ER company that hospitals use to find doctors. Patients may go to the ER believing that they’re covered only to find out that an out-of-network ER doctor from a service like EmCare worked on them. The result is a more expensive hospital bill.
How common is surprise billing? A National Bureau of Economic Research study found that patients who visited in-network hospitals for emergency care received out-of-network physician care 22% of the time. The Commonwealth Fund also released a report on surprise billing in June, which estimated that 14% of ER visits and 9% of hospital stays were likely to produce a surprise bill. One-fifth of admitted patients via the ER were more likely to receive a surprise bill.
The problem is that when people visit ERs it's usually for actual emergencies when patients are more concerned about their health than subsequent hospital bills. In many cases, these patients don’t have any other choice than to get care from an ER that might have out-of-network doctors. That doesn't even get into the issue of having an outsourcing ER company being considered out of network.
“When consumers feel very ill or experience a medical emergency, they usually do not have the time or presence of mind to determine whether a provider who treats them is out of network. Even if they know, they often have no opportunity to choose a network provider,” wrote The Commonwealth Fund study authors Kevin Lucia, Jack Hoadley and Ashley Williams, all of Georgetown University.
The report said only six states have comprehensive laws that protect against surprise billing and there are no federal protections against the practice. The Commonwealth Fund suggested states create legislation and regulations to limit surprise billing.
The new Texas law does just that and hopes to make it clearer for patients so they won’t get surprised by a higher-than-expected bill later. The law doesn’t fully resolve the issue of surprise billing, but it’s a step in the front direction for patients.
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