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Texans Who Get Surprise Medical Bills Are Often On Their Own. Groups Ask Lawmakers To Step In.

Gabriel C. Pérez

Consumer advocates and health insurers are pushing Texas lawmakers to address surprise medical bills during this year’s legislative session.

On Monday, the AARP of Texas, the Texas Association of Business, the Center for Public Policy Priorities, the Texas Association of Health Plans and others announced an effort to urge lawmakers to help Texans who receive unexpectedly high bills they assumed insurance would cover.

“We ask our [AARP] members ahead of session – every session – and get hundreds of responses about this issue specifically,” said Blake Hutson, the associate state director for the AARP of Texas.

People often receive surprise medical bills when they go to the hospital for an emergency and later find out the hospital or doctors there are out of network for their health plan.

In most cases, patients are left on their own to deal with the bill.

In the past few years, a state program has been playing an increasingly larger role in helping Texans handle those bills, though. The Texas Department of Insurance’s mediation program has been forcing health insurers and medical providers to get on the phone and come to an agreement that doesn’t saddle patients with huge bills.

The number of cases the program is handling is growing exponentially year after year. In 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.

The program is seeing results, too.

According to TDI’s figures, in 2018, it was asked to mediate surprise medical bills worth a total of almost $10 million. After mediation, the bills amounted to slightly more than $1 million.

“We think the problem is much, much bigger, though,” Hutson said, “likely some hundred thousand or so folks are getting surprise medical bills every year.”

Hutson said one reason more people aren't turning to the state is that it's up to patients to ask for help and patients don’t always know the program is available.

“We put all of the onus on the consumer to figure out how to do that,” he said. “And oftentimes folks are dealing with medical conditions where they don’t have the capacity to find out about this mediation system and go get it started.”

Information about the mediation program is supposed to be on a patient’s explanation of benefits or bill, which are difficult documents to read. Hutson said the information isn’t always included.

“What that has served to do in Texas is really limit the number of people who are getting helped,” he said.

A common form of surprise medical billing is balance billing, which is when a medical provider and an insurance company can’t agree on a price for the services a patient received. During balance billing, the patient is left covering those costs.

The Texas Medical Association said in a statement that health insurers are mostly to blame for surprise medical bills.

“TMA feels that until health plans are reined in from selling narrow-network products featuring inaccurate directories [contributing to patients getting surprise out-of-network bills], this problem will continue to grow,” Dr. Douglas Curran, TMA’s president, said in a statement. “The health plans need to be accountable to patients for the product they are selling and not pass the buck to the physician.”

TMA did not join the call for the Legislature to address surprise medical bills in a way that doesn’t leave the onus on patients.

The Texas Association of Health Plans, which did join the effort, says policies across the board are working against patients.

“Three hundred of Texas’ 407 hospitals have no in-network ER doctors available for the major three health plans, and almost 50 percent of all Texas ER doctor claims are out-of-network, which is substantially higher than for all other types of health care providers,” the group said in a press release.

The group said that’s why about 1 in 3 emergency room admissions in Texas results in a surprise bill.

“We still see it over and over again in the news — Texans constantly receive outrageously-high surprise medical bills for health care they receive in an emergency,” TAHP CEO Jamie Dudensing said in a statement. “We are committed to working with the legislature this session to put an end to surprise billing and make sure patients are no longer held hostage during these billing disputes.”

Clarification: A previous version of this story said Texas Association of Health Plans primarily blamed hospitals for surprise billing. The group says policies across the board are contributing to the problem.

Ashley Lopez covers politics and health care. Got a tip? Email her at Follow her on Twitter @AshLopezRadio.
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