Lawmakers and medical community divided on surprise billing legislation

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AUSTIN (Nexstar) — Texans left with surprise medical bills after receiving treatment told a panel of Texas Senate lawmakers patients should be left out of balance billing battles. 

Legislators on the Texas Senate Business and Commerce Committee heard testimony over Senate Bill 1264, filed by Chairman Sen. Kelly Hancock, R-North Richland Hills.  

“This problem in Texas is growing and it’s time to help get patients out of the middle of these disputes,” Hancock said. 

Currently, it’s often up to the patient to get help from the Texas Department of Insurance if they get a high medical bill they thought would be covered under their health plan. Balance billing occurs when a doctor, hospital or health care provider is out of network. An example is when a patient goes to a hospital that’s in-network for emergency care but is treated by an out-of-network provider. The Texas Department of Insurance has outlined the process over how patients can seek mediation. The program was expanded in 2015 and 2017 and the Texas Department of Insurance can help with surprise bills over $500 from emergency providers, including freestanding emergency departments and all out-of-network providers providing services at an in-network facility. 

But Hancock says the issue of patients getting expensive medical bills in the mail unexpectedly is a growing problem. His legislation prohibits surprise balance bills from being sent to consumers. They would still be responsible for their deductibles, co-pays and co-insurance.  

“If there is a dispute however, the providers and insurance are still able to seek mediation over disputes without a patient initiating the process,” Hancock said. “This is a strong consumer protection bill and addresses something all constituents face.” 

Drew Calver, a teacher in Austin, told lawmakers his story about receiving a surprise medical bill for $108,951 after receiving care for a heart attack in 2017. Calver has a federally regulated, self-funded health benefit plan. 

“For about 15 months, I was given this runaround, trying to sort it out, getting calls into insurance, calls to the hospital,” he said. “I got nowhere except for a lot of stress, a lot of fear. Finally, the hospital said, ‘Your insurance paid $55,000 of this $165,000 bill and you owe the balance of $110,000. You need to start paying it or we’re going to send you to collections.’” 

Calver’s story went viral and he attributes his bill being dropped down to $332 to media attention and public pressure. 

“Not everybody has the luxury of using the national media to fix their problems,” he told lawmakers. “But I think it resonated and it went viral because this can happen to anyone.” 

Dr. Jason Terk, a pediatrician from Keller, said the Texas Medical Association Council on Legislation said though physicians support protecting patients from out-of-network billing, the organization’s opposition to the bill stems from what he says is the root cause of balance bills: inadequate networks from health plans sold to consumers. 

“The modification of Texas law and the previously successful mediation process in a way that will disrupt the health care marketplace by favoring insurance companies,” Terk said. “In an out-of-network surprise billing situation, the patient and the insurer have the contractual agreement. The physician and the insurer do not. As a result, when we remove the patient from the claims settlement process, the insurer has little market accountability and less additional statutory protections are created.” 

Several anesthesiologists testified against the bill as well, also saying health insurance companies don’t provide network adequacy.

The legislation remains pending in committee. 

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