A Run To A Freestanding Emergency Room Shouldn’t Involve A Game Of Billing Roulette

April 16, 2019

If you have a sprained wrist or your child has bronchitis, then the facility where you seek treatment can be the difference between receiving a modest bill and a prescription or a surprise bill the size of next month’s mortgage.

The medical industry has too many sticker-shock surprises, and among the worst is the one that occurs if you wander into a freestanding emergency room thinking it is an urgent care center. This mistake could leave you looking at a $3,000 bill for out-of-network emergency room services that otherwise might cost less than $200 at an urgent care center when your insurance company refuses to pay the outrageous charges.  

There are benefits to a freestanding emergency room, such as shorter waiting times and expert care. But consumers need to know that emergency room care is the most expensive medical service, and how to figure out the type of treatment center that they are walking  into. And despite past efforts to help out patients, confusion still reigns.

Thankfully, state Rep. Tom Oliverson, R-Houston, a practicing anesthesiologist, wants to put an end to this confusion with a bill that would force standalone ERs to inform patients in writing of all health plans that are in-network, as well as any facility fees that would be charged. The bill, HB 2041, would also prohibit common confusing marketing practices, such as the use of logos and names of health plans on the facility’s signage, marketing brochures and websites, and impose tougher penalties for violations of state licensing requirements.

These reforms are long overdue. Since 2009, the number of freestanding emergency rooms in Texas has grown from zero to about 365 independent and hospital-affiliated emergency care operations, and account for a substantial percent of all out-of-network emergency facility claims in Texas.

The operators of freestanding emergency room say that they’ve gotten a bad rap. They blame insurance companies for not paying their share of treatment costs, thus leaving the facilities to hit patients for the remainder of the emergency room charges. They also claim that disclosure of the financial consequences would delay treatment and force patients to make health decisions based on their finances.

The reality is that consumers often don’t know whether they are experiencing a life-threatening medical emergency that would require emergency room level treatment. And that makes consumers especially vulnerable to making bad medical and financial  decisions.

Consumers need to be empowered to make wise medical and financial choices. Oliverson is on the right track with this bill, and we urge the Legislature to give patients the power and disclosures that they need to be informed consumers.