State legislation with bipartisan support is taking aim at "surprise medical bills" and may get a final vote Monday, May 20, in Austin. It's designed to protect the consumer by requiring medical providers and insurance companies to work things out themselves.
We've all heard horror stories about someone with insurance who's ER visit or surgery is followed by a crazy high bill in the mail.
"These are the kind of bills that occur when you have a medical emergency, you go to the hospital that’s in your network, you think you don’t have any problem, and then suddenly you get a bunch of surprise bills weeks later from providers inside of that hospital that weren’t part of your insurance network," said Ann Beeson with the left-leaning Center For Public Policy Priorities.
Those providers could be ER doctors, anesthesiologists — anyone the patient doesn't choose ahead of time. That's why the medical bills are a surprise. In the past, it was the patient's job to fight them.
"We had made progress the last couple sessions in creating a system that enabled consumers to access mediation to contest the bills," Beeson said. "And over 35,000 Texans over the last number of years have actually used that system to save over $30 million."
Beeson says the problem is, many more people get these bills than go to mediation.
"[In all] 250,000 Texans every single year go to the emergency room and get one of these surprise medical bills. And so that fix was only addressing a tiny fraction of the problem," she said.
Instead of a patient-initiated process, this legislation allows providers to dispute payments with insurance companies through arbitration.