Texas surprise-billing legislation leaves out employer-sponsored insurance

Texas legislation to address surprise medical bills will not protect millions of state residents, according to the Austin American-Statesman.

Various states have worked to protect patients from surprise medical bills that occur after they unintentionally receive out-of-network care in emergency situations or at in-network hospitals.

The law signed by Texas Gov. Greg Abbott June 14 takes effect Jan. 1. It includes arbitration as a means to resolve out-of-network payment disputes between providers and insurers and sets limits on negotiated rates, according to Reform Austin, a website providing nonprofit journalism.

Under the law, surprise medical bills are prohibited in circumstances where patients are unable to choose the provider they see or the facility they visit, said one of the bill's authors, Sen. Kelly Hancock, R-North Richland Hills. This includes medical emergencies, out-of-network care at in-network hospitals and out-of-network lab and imaging work.

But the Statesman reported that the law does not cover about 9 million Texans who don't have insurance regulated by the state's insurance department.

People who have insurance regulated by the state are typically teachers, state employees, small business workers and people who purchase their own coverage, according to the newspaper. Residents the law doesn't apply to are mostly people with employer-funded coverage regulated by the federal government.

The Texas law comes as Congress works to stop surprise medical bills at the federal level. Congress reconvenes in September.


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