Medical billing remedy passes
Landmark legislation to protect unsuspecting patients from surprise medical bills and shield them from disputes between insurers and health care providers soon will head to the governor’s office to become law.
Gov. Greg Abbott has signaled support of the bill and is expected to sign it. The law would go into effect Jan. 1, 2020.
“I think we got there,” said state Sen. Kelly Hancock, the author of the bill.
Hancock, a Republican from suburban Fort Worth, has fought to extend patient protections for more than a decade.
The victory became apparent when the legislation passed unanimously in the House on Tuesday and Hancock agreed to changes made in that chamber on Wednesday. The measure passed the Senate, 29-2, in April.
The sweep of the legislation has caught national attention, particularly among health economists, who long have tagged the state as having one of the worst records for surprise medical bills in the country. The passage of this bill and others catapults Texas into having some of the strongest patient protections in the nation.
Senate Bill 1264, along with complementary House Bill 3933, prohibit doctors from charging emergency room patients any or all of bill that insurance doesn’t pay. For years, patients have been financially devastated
by the business model known as balance billing.
Pocket protections
Also, under the new law, patients who have no control over who treats them also will be protected against balance billing, including cases such as an out-ofnetwork doctor at an in-network hospital or out-of-network lab work. They only will be responsible for in-network rates for out-ofpocket costs such as co-pays and deductibles.
This specific legislation, however, does not shield all patients, only those with state-regulated plans.
Separate legislation, also introduced by Hancock, to allow those with federally regulated, self-funded plans to opt-in to the protection failed. Many large employers in the state use self-funded plans, paying for health claims directly.
Hancock’s legislation on surprise medical bills was introduced Feb. 28 and later merged with a similar measure by Sen. John Whitmire, D-Houston, and Rep. Tom Oliverson, R-Harris County. Joining forces was considered a strategic move to show unity against opposition percolating within the health care field, lawmakers said at the time .
The powerful Texas Medical Association, which represents doctors in the state, initially opposed the Hancock measure, arguing it tilted the scale in favor of insurers. The group since has said it supports the legislation.
In addition to ending much of the state’s balance billing, the new law would also replace Texas’ existing mediation process with “baseball-style” arbitration where insurers and providers must submit a one-time, best-and- final offer for reimbursement. An independent arbiter then would determine how much gets paid.
Key to the new arbitration system would be removing patients from the process, Hancock said. Currently, not only must they initiate mediation, they also often are cajoled into taking sides between insurers and providers.
“I’ll tell you what, it’s exciting,” said Rep. Trey Martinez Fischer, DSan Antonio, who has worked with Hancock on the issue previously and introduced the House version of the legislation.
Despite more headline-grabbing bills in the 2019 session, such a property tax reform and school finance, Martinez Fischer said he thought this legislation could potentially have the most direct impact on Texans.
Health economists have reported a 27 percent likelihood of Texans getting an out-of-network bill after emergency room care — nearly double the national average of 14 percent. And insurance claims statistics have shown two of three out-of-network emergency physician claims in 2017 happened at an in-network facility.
Hancock introduced the first legislation on the issue in 2009, creating the state’s current mediation system. Over the years, it has been revised and strengthened twice. But the problem not only persisted, it worsened. At the start of this year’s session, Hancock and others predicted this could be the year of big change.
“I think insurance companies and providers dumped this expensive problem in consumer’s lap for a long time and the legislature pushed back hard this year and fully took care of it,” said Stacey Pogue, a health policy analyst at the Center for Public Policy Priorities in Austin, who has been tracking balance billing for a decade.
On Wednesday, she was thrilled, but also admitted surprise. “I would have said in February this is a good bill but it will not pass,” she said.
Texas lawmakers hope the law could serve as a model for others, including Congress, which has taken on the fight against surprise billing at the federal level.
More for patients
Other patient protection measures headed for the governor include preventing disputed medical bills from damaging credit ratings, giving the state attorney general the power to go after free-standing emergency rooms for “unconscionable” billing, and closing a semantic loophole on insurance coverage in the free-standing emergency room industry.
A Hearst Newspapers investigation in December found many area facilities prominently advertise they “take” or “accept” insurance plans but are, in fact, out of those insurer’s networks. This practice leads to patient confusion and leaves them unknowingly vulnerable to high out-of-network billed charges. That practice now will be banned.