Texas patients likely to be hit with surprise medical bills

Unhappy female patient and doctor
Texas has some of the highest rates of surprise medical bills in the U.S., according to a new study. (Getty/AlexRaths)

Patients in Texas may be at high risk for surprise medical bills, especially if they need emergency care, a new study of more than 300 hospitals in the Lone Star State has found.

Indeed, in the majority of cases, even if a hospital belongs to one of the state’s three largest insurers' networks, the analysis (PDF) from the Center for Public Policy Priorities found that none of the emergency doctors on the hospital staff are in those networks. That means unsuspecting patients will receive care from out-of-network physicians and will be hit with unexpected bills. 

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Only four emergency departments were in-network for all three of those payers, with all emergency physicians also in-network, according to the report.

The findings are similar to those from a November 2016 study that reported surprise billing rates reached 89% in areas of Texas. 

State legislators tried to mitigate the "balance billing" problem by launching a mediation program in 2009 designed to help patients who receive a surprise medical bill of more than $500.

However, few patients thus far have taken advantage of the program, according to the report. That's likely because they have to overcome several hurdles before they can request mediation. Since the program's launch, only 3,824 patients have accessed mediation, according to the report, which estimates that more than 250,000 Texans may face surprise bills in a two-year window.

“Texas has a good foundation in place with its existing mediation system, but changes are needed to ensure that patients can reliably access the help intended by the legislature,” according to the report. 

RELATED: Efficient, fair payer-provider negotiations first step in solving surprise bills

The report offers three principles to guide legislators as they seek a solution, strategies that are also applicable to states beyond Texas that are looking to assist patients with surprise bills or to avoid “balance billing” practices:

  • Protect patients who do not choose to receive treatment from an out-of-network provider. It's vital that hospitals adopt this strategy for patients who seek emergency care, the report noted. Patients must be insulated from surprise medical bills when they didn’t even have the chance to select an in-network doctor.
  • Create a transparent system for doctors and insurers to resolve disputes about surprise bills. Providers shouldn’t force patients to shoulder the burden of resolving billing disputes. The report suggests that providers and payers have protocols in place to solve them.
  • Make sure that mediation offered to patients does not contain loopholes. All patients who incur surprise bills, especially if it’s for emergency treatment, should have equal access to programs that can mediate the issue, the report said. 

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