Mediation Program In Texas Helps Patients Fight Surprise Medical Bills

May 12, 2019

Austin, Texas — Here’s a startling fact: In the U.S., nearly 60 percent of bankruptcies are caused, in part, by medical bills. So, finding ways to lower those bills has never been more important. A new program in Texas may be the solution.

When Stacey Shapiro, a first grade teacher, woke up last March, she was dizzy and out of breath. She knew something was wrong.

“I got real hot, sweating profusely,” Shapiro told CBS News. “I got very nauseous, so then I got up and then I passed out.”

The nearest hospital was out of her insurance network, but she knew the fine printin her policy.

“I remember reading, ‘in case of emergency … you go to the nearest hospital,'” she said.

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The diagnosis was low blood sugar. The real shock: the $6,720 bill for the medications and tests in a three-hour emergency room visit.

“One in every five patients that goes to an ER is going to get a surprise medical bill,” consumer health advocate Stacey Pogue told CBS News. “And in Texas it’s even higher; it’s 1 in 3.”

Nine months after paying her deductible and copay, Shapiro contacted the mediation hotline.

It’s a program unique to Texas: The Texas Department of Insurance sets up mediations between insurance companies and out-of-network hospitals to resolve surprise medical bills.

Within weeks, Shapiro’s bill was surprisingly settled.

“There had been a contractual adjustment and my bill had gone … to zero,” she said.

In 2018, the program negotiated $9.7 million worth of bills, saving patients $8.4 million in medical expenses. Some 8,000 Texans are expected to use the program in 2019.

“Eight thousand is a tiny share of the number of Texans who get surprise medical bills,” Shapiro pointed out.

A quarter million Texans get surprise medical bills over a two-year period.

“I’m so thankful this is over,” Shapiro said, adding, “I don’t want any more teachers to go through what I’m going through.”