TAHP Supports Legislation Against Surprise Medical Billing

The Dallas-Fort Worth Hospital Council and the Texas Association of Health Plans on Wednesday announced its support for Texas Sen. Kelly Hancock’s new bill significantly expanding protections against surprise medical billing for Texas consumers.

According to the Texas Department of Insurance, surprise medical billing, known as balance billing, occurs when insured patients receive out-of-network care, usually for emergency care, and are billed by a doctor, hospital or provider for fees that substantially exceed the amount paid by the insurance.

Stephen Love, president and CEO of DFW Hospital Council, said the council’s member hospitals are reviewing Sen. Hancock’s bill, reinforces legislation from the 84th Texas session regarding mediation for facility-based providers and surprise medical billing.

“[We] support transparency in hospital billing and have patient navigators to assist patients and families regarding hospital bills and billing practices,” Love said to D CEO Healthcare. “It is important to understand that hospital-affiliated, free-standing emergency departments accept payers like Medicare, Medicaid, etc., and bill in-network for their services.”

Love also emphasized the benefit Sen. Hancock’s bill would have if hospital-affiliated, free-standing emergency departments were implemented.

“The hospital-affiliated free-standing emergency departments provide access for patients within the communities with a full back-up of hospitals services, if warranted, based on the patient’s condition,” he said.

“This continuum of care and business model is much different than free-standing emergency departments that bill out-of-network and have no immediate hospital affiliation for backup of a full-service hospital system–and most do not accept government payers like Medicare and Medicaid.”

A statement from TAHP, the statewide association representing commercial and public health plans, said Sen. Hancock’s legislation, SB 507, “would expand mediation protections,” as it’s currently being used on a limited basis by consumers in Texas, for insured consumers.

If executed, Legislation SB 507 would provide the following:

  • Allow mediation of balance bills from all types of out-of-network providers treating patients at in-network hospitals, free-standing emergency rooms and more.
  • Allow mediation of balance bills for emergency care from any provider or facility of emergency care services
  • Expand disclosure requirements regarding network status and balance billing by insurers, facilities, and other healthcare providers. Providers also must include the disclosure that reads “this is a balance bill that may be eligible for mediation.”
  • Expand mediation protections to the Teachers Retirement System

Texas, including Dallas County, is home to some of the highest balance billing rates emergency costs in the nation. The Texas Department of Insurance information revealed balance billing complaints rose 1,000 percent in Texas, from 112 in 2012 to 1,334 in 2015.

Moreover, TAHP studies found up to 56 percent of hospitals in Texas that are in-network with the three largest insurers in the state have no in-network emergency physicians, and nearly 70 percent of out-of-network claims in Texas stem from freestanding ERs.

With the majority of the nation’s freestanding ERs located in Texas, TAHP CEO Jamie Dudensing said the organization “applauds Sen. Hancock’s efforts to better protect consumers against this growing trend.”

“[We support his effort] to require greater protections for consumers against surprise billing by free-standing ERs and other emergency care providers, and to ensure consumers have more options to challenge exorbitant, surprise medical bills often waiting for them in the mailbox after they’ve been treated in an emergency situation,” Dudensing said.

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