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Texans With Large Employer Health Plans Are Most Likely To Get Surprise Medical Bills, Study Finds

Spencer Selvidge for KUT

Texans who get their health insurance from a large employer are more likely to get a surprise bill in an emergency compared to people with similar plans in other states, according to research published Thursday.

The study from the Kaiser Family Foundation looked at claims data from large employer plans across the country. In particular, it focused on out-of-network charges associated with planned hospital stays and emergency visits, which often result in surprise bills.

"Of the emergency room visits in 2017 by people with large employer coverage, we estimate 18 percent [nationally] had at least one out-of-network charge (from either the facility, the provider, or both) associated with the visit,” the researchers found.

In Texas, that rate is 38 percent – the highest in the country.

“It’s a much bigger problem among workers in the state of Texas,” said Karen Pollitz, one of the study's authors.

Pollitz said Texas also surpassed the national average for planned hospital stays resulting in a surprise medical bill. Nationally, 16 percent of planned stays at in-network facilities “resulted in at least one out-of-network charge for a professional service,” researchers found. That rate was 27 percent in Texas. Only New York and New Jersey had higher rates.

Republican Gov. Greg Abbott signed legislation this month cracking down on the practice of surprise medical billing in the state. The law applies only to people who have state-regulated health insurance plans, however.

Pollitz said states are unable to regulate these large employer plans because they are federally regulated, which means many Texans won’t be shielded from surprise bills.

“So, even when states take the lead and try to adopt thoughtful and comprehensive solutions to this problem, those solutions won’t protect most of their private insured residents," Pollitz said.

One way for consumers to find out if their insurance is state regulated is to check for the initials TDI or DOI on their insurance cards, meaning it's regulated by the Texas Department of Insurance.  

U.S. Rep. Lloyd Doggett, D-Austin, has been working on a solution to surprise medical bills for Americans with federally regulated plans. He said there are various proposals members of Congress are considering.

However, until there is a federal solution, Doggett said it’s hard to curb the number of surprise bills Texans receive every year.

“Until a federal law is enacted of the type that I have been urging Congress to approve since 2015, Texans will continue to get hit with surprise bills,” he said.

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