Texans still vulnerable to surprise medical bills despite year-old state law to prevent them

More than a year after Texas enacted a transparency law, patients may still face high unexpected medical bills when they visit for-profit freestanding emergency rooms due to a lack of clarity over insurance coverage, according to the Houston Chronicle.

The finding comes from the Chronicle's recent review of websites representing more than 50 freestanding emergency rooms in the Houston area.

The review reportedly found that many facilities noticeably advertise that they "accept" all major private health plans. But websites often also include less obvious notification that the facilities are not in those insurers' networks and reference Texas insurance code requiring insurers to cover emergency treatment in out-of-network and in-network situations, according to the report.

Patients still may face high out-of-pocket costs if the facility is outside their insurer's network and they are billed for outstanding balances after the insurance company submits its portion.

Advocacy groups and Texas lawmakers have raised concerns about the issue, and at least one senior health policy analyst argues that "accept" has different meanings to facilities and patients and that facilities "do not tell the rest of the story," according to the report.

Carrie de Moor, MD, CEO of Frisco, Texas-based Code 3 Emergency Partners, a network of freestanding emergency rooms, urgent care clinics and a telemedicine program, told the Chronicle she doesn't see an issue because patients understand that accepting coverage is not the same as being in the insurer's network.

The Chronicle's review comes after Texas implemented transparency legislation last year requiring that the websites of freestanding emergency rooms properly identify the facility, disclose network status and  let patients know they may receive separate bills from both the facility and the physician providing care, according to the report.

Access the Chronicle's full report here.


More articles on healthcare finance:

Insurers, businesses and consumer advocates unite against surprise medical bills
New Mexico hospital taps consultant for billing
20% of Americans are deferring healthcare because of cost, poll finds

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Whitepapers

Featured Webinars