New Texas surprise-billing law may strip protection for some patients

Kelly Gooch - Print  | 

A proposed expanded exception in Texas' new surprise-billing law could lessen the effectiveness of the legislation, consumer advocates in the state told NPR radio station KUT.

The law, signed by Gov. Greg Abbott June 14, takes effect Jan. 1 and applies to residents who have insurance regulated by the Texas Department of Insurance.

It bans surprise medical bills in circumstances where patients are unable to choose the provider they see or the facility they go to, said state Sen. Kelly Hancock, R-North Richland Hills, who sponsored the legislation. This ban aims to protect patients in circumstances such as medical emergencies, out-of-network care at in-network hospitals and out-of-network lab and imaging work.

Once the patient is protected, the law includes an arbitration process, under which insurance companies and providers can resolve out-of-network payment disputes.

Yet consumer advocates told KUT a proposed expanded exception in the law could make the protection for patients "irrelevant."

"The financial struggle that legislators were trying to remove us from — trying to protect us from — patients might be right back in the middle of that situation," Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, told the station.

At issue are rules state officials are working on to implement and enforce Texas' new surprise-billing law, particularly rules proposed by the Texas Medical Board.

Ms. Pogue told KUT a board proposal would expand the use of an exception intended for patients who knowingly want to receive nonemergency care from a specific out-of-network provider.

Under Texas' surprise billing law, those patients would be able to waive their protection from out-of-network costs. The medical board's proposal would expand that to require all out-of-network providers in nonemergency situations to provide the waiver to patients, according to KUT. Consumer advocates contend this could mean patients still end up with surprise medical bills if they sign the form not fully understanding they are waiving their protection against out-of-network costs.

Texas Medical Board spokesperson Jarrett Schneider defended the proposal.

"The patient must have five business days to consider whether to accept and may not agree prior to three business days after the notice was provided," he told KUT. "This allows for a cooling-off period so the patient has adequate time to decide whether to proceed if there are, in fact, out-of-network charges."

The station reports that the board could potentially adopt its proposed rules in December.

Read the full KUT report here.


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