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'Balance Bills' Can Hit Texas Consumers Hard After Hospital Visits

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Spencer Selvidge/KUT
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A new report from the Center for Public Policy Priorities shows that in Texas, and many states in the U.S., people are getting what’s called a balance bill after visiting the ER.";

Texans may find surprise charges after visiting an emergency room, according to a new report from the Center for Public Policy Priorities. How they find out about them is when an unexpected piece of mail arrives. 

Most people who have insurance think they know what they’re responsible for when it comes to paying for medical care at a hospital, if they visit one in their insurance provider's network, but in Texas, and many states in the U.S., people are getting what’s called a balance bill.

"When you’re on the way to the emergency room, not only can you not, from the back of the ambulance, look up and see who’s in network, once you’re at the ER, you can’t request physician A over physician B," says Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities.

The left-leaning think tank released a report this week [read PDF version here] on these balance bills. Let’s say that doctor bills a $1,000 for her services, but she doesn’t have a contract with your insurer and your insurer will only pay $600. You’re on the hook for the other $400 because you got billed for out-of-network services even if you visited an in-network hospital.

Consumer advocates like Stacy Pogue say doctors and insurance companies need to agree on what’s a fair price up front. While non-ER physicians might want to get in network, ER doctors have a different incentive.

"ER doctors have a very different incentive, and I’d say lack incentive, to join an insurance company network," Pogue says. "It’s not going to increase the volume of clients they see."

At a hearing this week, lawmakers heard testimony from experts about the how little consumers know about their medical costs.

In Texas, insurers must provide a list of physicians in network on their websites, but State Sen. Leticia Van de Putte, D-San Antonio, said she’s finding those lists are sometimes outdated. She asked an insurer how often they’re updating the list.

"And they said, 'Well, we update it pretty regularly.' And I said, 'No, this physician has been dead for two years.' And they said, 'How do you really know that?' And I said, 'Because I gave the eulogy."

The Texas Department of Insurance is working on a website aimed at boosting price transparency. You will be able to put in the details of a procedure, where you’re getting it done, and get a ballpark idea of how much it’ll cost, depending on what insurance you have.