Hospital bill mediation requests spike in Texas

Texans are increasingly taking advantage of the state's billing mediation program as they face unexpected out-of-pocket medical costs, according to KUT FM 90.5, a public radio station in Austin.

The Texas Department of Insurance mediation program aims to help patients with surprise medical bills by working with the health insurance company and the healthcare provider to reach an agreement on the amount charged by the provider, the amount paid by the insurer to the provider, and the amount paid by the patient. 

Surprise bills can occur when a patient unknowingly receives care from a physician, hospital or other healthcare provider that is out-of-network with their insurance company. The patient is charged the remaining balance after the insurance company pays its part of the bill. Through the state insurance department, eligible Texas patients can ask for mediation for their insurance claim.

The mediation program was recently expanded, and billing remediation requests have climbed, according to the report. State data obtained by KUT show that the insurance department was asked to mediate 686 medical bill disputes in fiscal year 2014, compared to 2,063 bills in 2017 and 4,445 bills in 2018.

Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, partially attributed the growth from 2017 to 2018 to "increased awareness."

"There is constant media attention now to surprise medical bills, because the stories are so shocking. We see them covered more, so people are more aware that when they get one they could do something about it," she told KUT.

Ms. Pogue told the radio station that the Texas Legislature also expanded the mediation to more people in 2017, including teachers.

Overall, the state found the 2018 fiscal year mediation requests represented $9.7 million in medical bills, which fell to $1.3 million after teleconferences and negotiations between the insurance company and the hospital or medical provider.

Access KUT's full report here.


More articles on healthcare finance:

6 must-reads about surprise medical bills
High court hears arguments in Medicare hospital reimbursement case
Intermountain, Regence BCBS partner to end surprise ER bills

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