Texas is taking the initiative with a bill that will protect patients from shockingly high hospital charges. It’s a measure that will tackle the problem at its source. Texans will have better protection against surprise billing with the bipartisan Texas Senate Bill 1264 introduced by Senator Kelly Hancock, R-Fortworth and Rep Trey Martinez, D-San Antonio.
It will address the way providers use their out-of-network status to charge patients by using what’s called balance billing. Surprise billing occurs when patients are unaware of the network status of their provider. Following a visit to the provider, after they have received care, only then will patients learn of the true cost of their medical care.
When patients are seen by out-of-network providers, insurance companies will not pay part or all of the bill. Even when the status of the facility is in-network, patients might still see a physician who is out-of-network. This mostly occurs at stand-alone emergency rooms, according to insurance data reported by the Houston Chronicle. It accounted for 83% of the out-of-network claims.
The Texas Senate Bill 1264 will protect patients who are overcharged even when seeking in-network care. By giving patients the clarity upfront, they won’t be hit with surprise charges after their hospital visit. This will include protections for emergency care and for the times when patients go to an in-network facility and are charged by providers they didn’t choose. It will also ensure patients isn’t charged for anything the insurance doesn’t cover.
In 2009, Sen. Hancock helped form a mediation process of patient medical bills, which didn’t fully solve the surprise billing problem. Patients were still being charged in the same way for the out of network care they received without their knowledge. This bill will require providers to clearly state their network status and let the consumer decide which care they would prefer based on the information provided. Meaning, they’ll have a choice in accepting or denying out-of-network care.
While the bill will resolve the way providers inform their patients of their network status, some have voiced concerned about the limitations of the bill. Dr. Douglas Courran of the Texas Medical Association, one of the largest in the nation, feels that measure should also address insurance companies and the way their plans and networks are constructed.
Even with the limitations, it is the greatest legislation that will tackle the surprise billing and protect consumers from paying high provider charges.