Bill would allow patients
to take all balance billing cases to mediation
March 25, 2015
The Texas Legislature may
be on its way to helping millions of Texans who get unexpected medical bills
every year due to confusion over which facilities and which doctors are part of
their insurance network.
A tip of the hat goes to
state Sen. Kelly Hancock who has introduced Senate Bill 481, which got a hearing Tuesday in
the Business and Commerce Committee. The Republican from North Richland Hills
wants to expand a mediation program that helps settle the bills when a doctor
working at a hospital doesn't accept the same insurance plans as that hospital.
Millions of Texans every
year experience this disconnect. The insurance company tells them a hospital is
part of the insurance network, but then they see a doctor there who is
out-of-network. The insurance company refuses to pay the doctor's full-fee, so
the patient gets an unexpected bill.
A few months ago I wrote about
this scenario and readers flooded
me with mail about their experiences with what is known as balance
billing. These patients developed elaborate plans to make sure all of the
doctors involved were in-network, only to discover the hospital made a
last-minute substitution that cost the patient thousands of dollars. The
practice was also the subject of several New York Times
stories.
Surprise medical bills
are the No. 1 cause of bankruptcy and bad credit ratings. Since doctors focus
on treating patients rather than who will pay them, patients frequently don't
know that their insurance won't pay for the doctor until weeks after treatment.
Hancock wants to expand a
state law that allows patients to take some of those bills to mediation so that
patients can appeal EVERY bill they receive from out-of-network doctors working
at in-network hospitals. The bill would also help with emergency room visits
that the patient could not have predicted.
In addition to my
endorsement, the Texas Association of Business, the Center for Public Policy
Priorities and AARP all think this is a great bill.
"It is our hope that
the Legislature will recognize this serious problem and quickly pass this bill
to address it," the TAB's Bill Hammond said. "The practice is not
fair for consumers and is not fair for businesses, who struggle to provide
health insurance for their employees."
Hancock heard the
complaints, and while his bill will not end the practice, it does expand the
current law to cover more cases. If he can rally his fellow lawmakers to pass
it, it will be a step in the right direction.
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