Texas Sharpens Aim At Surprise Medical Bills In Bipartisan Proposal

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A bipartisan group of Texas lawmakers announced plans this week to address surprise medical bills in a way they believe would ease the burden on patients in the state.

During a news conference Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, announced he had filed a bill in the Texas Legislature aimed at preventing medical providers from, among other things, balance billing patients — charging patients the difference between what the health care provider and the medical insurer think a medical service or procedure is worth. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is filing a similar bill in the House.

If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of SB 1264 is to take "the burden off of patients."

"[It] takes it off of their plates completely," Hancock said.

He highlighted the case of Drew Calver, a public school teacher in Austin whose six-figure hospital bill after a heart attack was featured in a "Bill of the Month" investigation last summer by NPR, Kaiser Health News and KUT, NPR's member station in Austin. Hancock noted Calver's bill was reduced after the media attention but said it shouldn't take such attention for a patient to get a reasonable bill.

Under this legislation, both sides of the payment dispute would settle their issues through an existing balance bill mediation program. The Texas Department of Insurance program has been successful in lowering medical bills across the state.

The legislation would beef up the program, which addresses surprise balance bills greater than $500 from all emergency providers — including free-standing emergency departments and all out-of-network providers working at a network facility.

"This is designed to apply in situations where patients don't have any choice which facility they go to or which physician is involved in their care," Hancock said.

Historically, the Insurance Department's mediation program had many loopholes, and few consumers qualified for help. It was expanded in 2017, though, and more patients have been filing complaints.

For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.

Hancock said the program, so far, has saved Texas patients $30 million.

Still, consumer advocates argue, the system works only when patients know mediation is an option.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, said patients don't always know help is available, or they find the process intimidating.

"The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get," she told KUT earlier this year.

She and others have argued Texas should adopt a program similar to those in other states like New York, California and Florida, whose systems are more consumer-friendly.

Martinez Fischer said it's time Texas officials stepped in to help patients who are caught in the middle of disputes between medical providers and health insurers. "It has been an industry issue for a few years, I grant you that — the health plans and the providers fighting over their business interests," he said. "And I respect that. But 10 years later, it is a consumer issue."

Among other things, Hancock's bill would allow people with federally regulated, self-funded health plans to opt into the state's mediation program. According to Hancock, those plans make up about 40 percent of Texas' insurance market, but those consumers are currently not able to take part in the program.

Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.

"Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level," Hancock said. "Until then, Texas ... [is] committed to doing something about it."

U.S. Rep. Lloyd Doggett, a Democrat who represents Austin in Congress, said he is encouraged by Texas' efforts but called federal protections "essential."

"Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers," Doggett said in a written statement.

This story is part of NPR's reporting partnership with KUT and Kaiser Health News, an editorially independent news service of the Kaiser Family Foundation. You can follow Ashley Lopez on Twitter: @AshLopezRadio