Ambulance charges targeted.
The Texas Department of Insurance urged lawmakers to close a loophole in the state’s patient protection law that allows out-ofnetwork ambulance companies to charge unsuspecting consumers exorbitant bills.
In 2019, lawmakers passed sweeping legislation to curb crippling out-of-network medical bills in emergency situations or when patients had no choice of who treated them. It also took many patients out of the middle of fights over billing between insurers and providers. That measure, Senate Bil 1264, was applauded as one of the toughest patient protection laws in the nation.
But there was a notable exclusion: air and ground ambulances.
If those ambulance rides are out of network — and most in Texas are — patients unknowingly can be stuck with thousands, if not tens of thousands, of dollars in charges that their insurer did not pay, with little recourse.
The Texas Department of Insurance, a state agency, on Thursday called for lawmakers to change that in the upcoming legislative session, which starts Jan. 12. TDI requested lawmakers “amend the state’s protections against medical balance bills when the consumer doesn’t have a choice of providers to include ambulance services.”
Recent insurance data submitted to TDI showed that more than 85 percent of ground ambulance services and more than 60 percent of air ambulance services are billed as out of network, the agency’s new report to lawmakers shows.
A Hearst Newspapers investigation last month found that all city-run ambulance service in Houston is out of network for all insurance companies. That all but assures a surprise medical bill after a 911 call even if the patient has insurance.
Statewide, up to 90 percent of private ambulance services are out of network for some or all major insurers, the president of the Texas Ambulance Association said.
City leaders in Houston have said they have no choice but to stay out of insurance networks because ambulance rates are set by ordinance and the city does not have the ability under the Texas Constitution to charge less if an insurer reimburses at a lower rate.
Private ambulance companies have similarly said they remain out of network because insurers do not pay them enough and sometimes they have no choice but to pass the remainder of the charge onto patients to make up the difference.
Lawmakers and health policy experts say ambulance services are often excluded from the growing number of patient protection laws across the country because there are so many variables within the ambulance industry in operations and pricing, which makes oversight difficult.
Still, state Sen. Kelly Hancock, R-North Richland Hills, and state Rep. Tom Oliverson, R-Houston, both of whom have been leaders in the Texas fight against surprise medical bills, have said they would be willing to explore billing safeguards that include ambulance service during the upcoming legislative session.
Stephanie Goodman, a spokeswoman for TDI, said Thursday that the state has tried in the past to offer some protection against surprise ambulance bills but that a lawsuit filed in 2018 challenged those measures, saying the agency had overstepped its authority.
A state District Court in Travis County ruled against the agency in October, striking down the protections, she said.
“That left patients without protection against potentially large ambulance bills,” Goodman said, “so we thought it was important to put this issue back in front of the Legislature.”