Surprise Medical Bills: A Problem Not Just for the Unsuspecting but the Wary, Consumers Say

AUSTIN — Texans slammed with health emergencies – as well as those scheduling elective procedures — need more protection from surprise medical bills, consumer groups told lawmakers Wednesday.

A Lubbock woman with multiple sclerosis and a consumer advocate said that even the most conscientious patients are subject to “balance billing,” which happens when health insurers pay less than they expected or not at all.

“There’s still much work to be done to protect consumers from these surprise, out-of-network bills – particularly in emergency situations,” Natalie Steadman, a Lubbock physical therapist who used to be Texas Tech University’s head athletic trainer, testified before the House Insurance Committee.

Speaker Joe Straus, R-San Antonio, has asked the panel to study whether more transparency about health insurers’ provider networks and more regulation of the carriers and caregivers are needed to tamp down “disputes over out-of-network services.”

Grievances are on the rise.

Last year, 1,062 patients upset about balance billing requested mediation from the Texas Department of Insurance, a more than sevenfold increase in just two years, testified Doug Danzeiser, the department’s director of life and health policy lines.

Steadman, who has multiple sclerosis, recalled having a seizure while at a basketball game. EMS personnel took her to a hospital emergency room, she said.

“I barely remember even being there, much less being in a position to ascertain whether the people taking care of me were in network or not,” Steadman said. “To believe that’s a possibility, even … is a big stretch.”

Stacey Pogue, senior policy analyst at the center-left think tank the Center for Public Policy Priorities, said Texans recovering from emergencies should not have to jump over bureaucratic hurdles to fend off surprise bills for hundreds, even thousands of dollars.

Since 2009, Texas has had a mediation process, Pogue noted. But the patient has to trigger it. It doesn’t apply to out-of-network facilities, whether hospitals or freestanding emergency rooms.

“We hear reports from these consumers that are locked out” of state mediation assistance, she said.

Among the unprotected are those who rush in an emergency to the nearest hospital or urgent care center, only to learn later it is out of network, Pogue said.

Even if someone is at an in-network hospital, the emergency doctors there often have not signed up with insurers. If they bill for less than $500, the patient has no recourse.

Mediation covers only six types of doctors who practice in hospitals – radiologists, anesthesiologists, pathologists, emergency doctors, neonatologists and assistant surgeons. If a lab procedure or service at the hospital is provided by another type of provider, and the provider doesn’t have a contract with the insurer, the patient is out of luck.

“One of the stories we hear most often is ambulances,” Pogue said.

In a written presentation, she recounted the story of a Richardson man identified only as “Terry.”

After an emergency, he got a $992 bill from a ground ambulance. The ambulance provider would not negotiate and turned the bill over to a collection agency, which hurt Terry’s credit, Pogue said.

Top health insurer lobbyist Jamie Dudensing, who heads the Texas Association of Health Plans, said emergency care “is the big driver” of balance bills.

She called for expanding mediation protection for patients receiving any kind of out of network service at an in-network hospital.

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