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Texas Lawmakers Want To Take Patients Out Of The Equation In Medical Bill Disputes

Spencer Selvidge for KUT

A bipartisan group of lawmakers announced plans to address surprise medical bills in way that would take the "burden" off Texans.

During a press conference Thursday, Republican state Sen. Kelly Hancock of North Richland Hills announced he had filed a bill aimed at preventing medical providers from balance billing patients, among other things. Democratic state Rep. Trey Martinez Fischer of San Antonio is filing a similar bill in the House.

If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of Senate Bill 1264 is to take “the burden off of patients.”

“[It] takes it off of their plates completely,” Hancock said.

RELATED | Texans Who Get Surprise Medical Bills Are Often On Their Own. Groups Ask Lawmakers To Step In.

He highlighted the case of Drew Calver, a public school teacher in Austin who received a six-figure hospital bill after a heart attack. Hancock said Calver's situation was addressed by media attention, but it shouldn't happen this way.  

Under this legislation, both sides of the payment dispute would settle their issues through an existing balance-bill mediation program. The Texas Department of Insurance (TDI) program has been successful in lowering medical bills across the state.  

The legislation would beef up the program, which addresses surprise balance bills greater than $500 from all emergency providers, including freestanding emergency departments and all out-of-network providers working at a network facility.

“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock said.

The TDI mediation program, historically, had many loopholes and few consumers qualified for help. It was expanded in 2017, though, and  more patients have been filing complaints.

RELATED | Faced With Surprise Medical Bills, Some Texans Have Recourse. But The System's Not Perfect.

For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.

Hancock said the program, so far, has saved Texas patients $30 million.

Consumer advocates have argued the system works only when patients know mediation is an option, however.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, has said patients don’t always know help is available or they find the process intimidating.

“Because first, the instructions for how to do it are on your medical bill and your explanation of benefits – the most indecipherable documents you are going to get,” she told KUT earlier this year.

She and others have argued Texas should adopt a program similar to those in states like New York, California and Florida, which have systems that make things easier for consumers.

Fischer said it's time Texas officials step in to help patients who are caught in the middle of disputes between medical providers and health insurers.

“It has been an industry issue for a few years – I grant you that,” he said, “the health plans and the providers fighting over their business interests, and I respect that. But 10 years later it is a consumer issue.”

Among other things, Hancock’s bill allows people with federally regulated self-funded health plans to opt into the state’s mediation program. According to Hancock, those plans make up about 40 percent of Texas’ insurance market, but those consumers are currently not able to take part in the program. Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.

“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock said. “Until then, Texas … [is] committed to doing something about it.”

U.S. Rep. Lloyd Doggett said he's encouraged by Texas' efforts, but called federal protections "essential."

"Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” he said in a statement.

Copyright 2020 KUT 90.5. To see more, visit .

Ashley Lopez joined KUT in January 2016. She covers politics and health care, and is part of the NPR-Kaiser Health News reporting collaborative. Previously she worked as a reporter at public radio stations in Louisville, Ky.; Miami and Fort Myers, Fla., where she won a National Edward R. Murrow Award.