Texas sees dramatic rise in balanced billing complaints: 3 things to know

The number of Texas patients complaining about unexpected medical bills has increased dramatically in recent years, a KVUE investigation found.

Here are three things to know about the trend.

1. The number of balanced billing complaints — where a patient is told their procedure is covered by insurance, but later learn it was not, and then receive a surprise bill in the mail — increased from 112 in 2012 to 1,334 in 2015, according to KVUE, which cites information from the Texas Department of Insurance. That's an increase of 1,000 percent.

2. The increase in Texas patients complaining about unexpected medical bills comes as federal lawmakers want to make balanced billing illegal, according to KVUE. Twenty-five lawmakers, including U.S. House Rep. Gene Green (D-Texas), are supporting legislation that would do just that. It's called the "End Surprising Billing Act."

"People shouldn't have that surprise. There ought to be a way that they get notice that there are no network doctors in that particularly facility. It's happening in the Houston area and Austin, I know," Rep. Green said, according to KVUE.

3. The Texas Medical Association attributes Texans receiving these unexpected bills to insurance plans' network designs and payment decisions.

"Inadequate and limited physician networks that insurers sell today are leaving patients with unpaid bills and making the news. Unfortunately, when Texas consumers most need coverage, especially in emergencies, they are discovering the limitations of the coverage they have purchased," wrote the TMA in a 2015 report about balance billing. "The consumer is no longer satisfied with the not-very-well-explained, varying levels of savings that insurance network products create, especially if that means a greater financial burden in emergencies. Yet, despite network shortcomings, consumers do not want to be left without the choice of managed care health plans that offer network benefits."   

Read the full report here.



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