AUSTIN — The House voted 129-11 on Wednesday in favor of the Senate’s version of a bill that will force freestanding emergency rooms and other out-of-network providers into mediation with customers who dispute surprise bills under a state program launched in 2009.
Senate Bill 507 also requires that bills sent to patients include a prominent explanation of the mediation process. The legislation was passed in the Senate in late March and approved by the House Insurance Committee on Tuesday.
Surprise medical bills, also known as balance bills, typically arise when patients seek care at an in-network facility, such as a hospital, but are treated by an out-of-network provider. A recent study by the Center for Public Policy Priorities found that more than 300 hospital emergency rooms in Texas do not have a single ER doctor covered by the state’s three largest insurance plans.
Beyond the standard hospital emergency rooms, over the past five years Texas has seen a boom in freestanding emergency care centers, with more than 200 currently in operation. These account for nearly 70 percent of out-of-network emergency claims, according to Texans for Affordable Healthcare, a coalition of insurance companies, hospitals, and underwriters that supports legislation to rein in costs.
Recent research has found that Texans are more likely to receive surprise medical bills than residents of most other states. State residents have a 34 percent chance of receiving an unexpected bill as a result of being admitted to a hospital through the emergency room, compared to 20 percent nationwide, according to a report published in Health Affairs in February.
In 2009, the state adopted a mediation process for surprise bills arising from hospital ER visits, but it appears that few of those eligible have taken advantage of the option. Only 3,800 patients have sought mediation since the program’s introduction, while the Center for Public Policy estimates 250,000 people covered under eligible health plans will receive surprise bills for out-of-network services within a two-year period.
The House also voted on Wednesday for final passage of a bill requiring freestanding emergency rooms to provide notice of whether they participate in any health plan networks, since many do not. House Bill 3276, sponsored by State Rep. Tom Oliverson, R-Cypress, aims to clarity the status of these facilities in order to help patients avoid surprise bills later on.
Another pair of bills that would limit how much freestanding emergency care facilities can charge for services have been left pending in their respective Senate and House committees.