Sweeping legislation takes aim at shock emergency room bills in Texas

[Elderberry]

WacoTrib by JAY ROOT and SHANNON NAJMABAD 3/2/2019

With more and more Texans seeking relief from shock medical bills, two prominent lawmakers — one Republican, one Democrat — are pushing far-reaching legislation that would bar emergency care providers from sending surprise bills to patients covered by state-regulated plans.

Typically, the unexpected and often confusing bills result when disputes between out-of-network doctors and insurance companies leave patients holding the bag — even if they had no choice in selecting their medical provider.

But now, state Sen. Kelly Hancock, R-North Richland Hills, and Rep. Trey Martinez Fischer, D-San Antonio, want to keep those disputes from spilling over onto patients' bills. They unveiled their bipartisan legislation at the Texas Capitol Thursday.

“Thousands receive unexpected and frankly unreasonable surprise medical bills every year,” said Hancock, the chairman of the Senate Business and Commerce Committee. “Enough is enough.”

Martinez Fischer, who heads the House Business and Industry Committee, said insurance companies and medical providers should work out their disputes without dragging consumers into it — and often saddling them with huge bills.

“Why should a patient get caught up in the middle?” said Martinez Fischer. “We’re going to put the patients’ interests first.”

The legislation’s filing comes as patients' requests for state help with out-of-network ER bills are skyrocketing. The Texas Tribune reported earlier this month on a backlog in the state’s mediation program, which allows many insured patients to force their providers and insurers into a negotiation that often lowers the bill dramatically.

The state's mediation program was created in 2009 by legislation Hancock authored. Reforms passed in 2015 and 2017 lowered the threshold to participate, dramatically expanding the number of patients eligible. Regulators believe those changes, as well as media attention, contributed to the surge in requests.

More: https://www.wacotrib.com/news/health/sweeping-legislation-takes-aim-at-shock-emergency-room-bills-in/article_dbed0459-9fe1-5df5-9c8a-5cae9941cb04.html