Since 2009, a state mediation program managed by the Texas Department of Insurance has allowed patients with certain health insurance plans to remain off the hook for large and unexpected medical bills while their insurer and health care provider agree on a payment.

Here's an update on how that battle over medical bills has fared.

Help needed

The state lowered the threshold in 2015 to include any bill of $500 or more. Until January, the program was only available to people in the Employees Retirement System and preferred provider organization plans.

Now it includes the Teacher Retirement System — and patients can submit bills from hospitals, ambulatory surgery and birthing centers, and freestanding emergency rooms. More people are seeking help.

"Providers and insurers have always argued over reimbursement. Providers are accepting less than their billed charges through the mediation process, but they also accept less in other circumstances, such as when they've negotiated contracts with carriers. TDI's role is to get the insurers and the providers together to discuss the bills. The mediation process provides a way to take these disputes before a neutral mediator, and sometimes before a judge."

Ben Gonzalez, spokesman for the Texas Department of Insurance

Adding up

Most of the requests for help are for bills that are greater than $1,000. And so far this year, about 11 percent are for bills that are greater than $5,000.

"As new policies are introduced that could make it more challenging for consumers to decide when and where to seek emergency care, it's important to look at the impact. Unexpected medical bills can be a huge financial burden for consumers. The increasing number of mediation request demonstrate the demand and show that Texans are looking for tools to deal with medical expenses."

Sabriya Rice, staff writer, The Dallas Morning News

Footing the Bill

Mediation requests do not qualify if the health insurance plan is not eligible or the amount of the bill is too small. The Texas Department of Insurance says it has intervened in over $15 million in medical bills since it began to track the payout amounts in 2015.

"It's important that when we pass legislation we pay close attention to how it's working — and that's what we've been doing with balance billing mediation, making improvements each session since we first established the program. We track and release these statistics each month to monitor the effectiveness of the program, look for ways to make it better, and of course to keep spreading the word to patients that balance billing mediation is available when they're getting hit with these surprise medical bills."

Sen. Kelly Hancock, R-North Richland Hills

No deal?

When insurance companies and medical providers can't agree on a bill payment amount, the Insurance Department elevates the case to the State Office of Administrative Hearings, where a judge decides. Not surprisingly, mediated cases are being elevated more frequently.

*A previous version of this story said judges were intervening in mediated cases more frequently. While cases are being elevated to judges more frequently, sometimes they are settled before a judge decides.