Texas Cracks Down On Surprise Medical Billing

Texas is the latest state to pass a law to shield patients from surprise medical bills. These bills are often sent to patients who unintentionally go out of network, sometimes in emergencies.

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Texas is now among more than a dozen states that have cracked down on surprise medical bills. Governor Greg Abbott signed a law late last week. It aims to shield patients from huge bills when the insurance company and the hospital can't agree on payment. Ashley Lopez of member station KUT reports from Austin.

ASHLEY LOPEZ, BYLINE: High school history teacher Drew Calver’s life is fairly normal now.

DREW CALVER: Susanna (ph).

LOPEZ: He and his wife, Erin, are trying to track down goggles as they get their two young daughters ready for swim lessons.

UNIDENTIFIED CHILD: (Singing) We are piranhas...

LOPEZ: But two years ago, Drew had a dangerous heart attack. And even though he had health insurance, Drew ended up with a $109,000 bill from the hospital because the hospital he went to in Austin was out of network. Calver's wife, Erin, says she was shocked because it was an emergency.

ERIN CALVER: I guess we never thought something like this could happen to us. And then when it did, we we understood, like, people are being exploited.

LOPEZ: The Calvers fought with the hospital and Drew's insurance company for months and eventually turned to the press. Last summer, Drew's story was part of a Bill of the Month investigation from NPR and Kaiser Health News. Shortly after, his bill was slashed to just $330. Erin says it was resolved for them, but the conversation kept going.

E. CALVER: For whatever reason, people just - they could relate to us and be scared that maybe it could happen to them, right?

LOPEZ: Drew heard the same thing.

D. CALVER: The doctor that put my stents in, you know, he either just had a baby or he's about to have a baby. And he was saying that, yeah, it could happen to me too.

LOPEZ: In fact, most Americans say they worry a lot about getting a steep hospital bill. Stacey Pogue is with the Center for Public Policy Priorities in Austin.

STACEY POGUE: Polling shows us that it is the top household pocketbook concern for consumers, is a surprise medical bill. And that's actually pretty shocking.

LOPEZ: State Senator Kelly Hancock, a Republican, has been working on this issue for more than a decade. He says this year the complaints were louder than ever.

KELLY HANCOCK: We wanted to do two things. We want to try to take the patients, get them out of the middle of it because really, it's not their fight.

LOPEZ: Hancock says that fight is between the insurance companies on one side and the hospitals, doctors and labs on the other. He says his other goal was to make sure there was a clear way for both sides to figure stuff out.

HANCOCK: We wanted to maintain some level of negotiation between the parties. We just - it was just time to get the patient out because, frankly, the patient was nothing more than a pawn.

LOPEZ: Texas' law now requires both those parties to enter arbitration when they can't agree on a price. Stacey Pogue says she's pretty happy with the new law.

POGUE: It is as strong or stronger than any of the protections in the country. There are only maybe a handful, less than - fewer than 15 states now that have a comprehensive solution for consumers. And Texas is now on that list.

LOPEZ: But Texas' law only goes so far. The new law will only shield Texans with state-regulated plans from surprise medical bills. However, 40% of plans in Texas are regulated by the federal government. So Pogue says those Texans can only be protected if Congress does something.

POGUE: And I think Texas passing a bill will really help on that front.

LOPEZ: Texas is just one of several states that has passed a law like this in 2019. And Congress is looking at the problem but hasn't settled on a solution yet. For NPR News, I'm Ashley Lopez in Austin.

CORNISH: This story comes to from a reporting partnership between NPR, KUT and Kaiser Health News.

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