This story is a part of a partnership that features KUT, NPR and Kaiser Health News.
This story will be republished at no cost (details).
A bipartisan group of state lawmakers introduced plans to deal with shock medical payments in a approach that might take the “burden” off Texans.
During a press convention Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, introduced he had filed a bill aimed toward stopping medical suppliers from balance-billing sufferers, amongst different issues. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is submitting an identical invoice within the House.
If handed, the laws would pressure medical suppliers and well being insurers to mediate fee disputes earlier than they ship payments to sufferers. Hancock mentioned the purpose of SB 1264 is to take “the burden off of patients.”
“[It] takes it off of their plates completely,” Hancock mentioned.
He highlighted the case of Drew Calver, a public faculty instructor in Austin whose six-figure hospital invoice after a coronary heart assault was featured in a “Bill of the Month” investigation by KHN, NPR member station KUT and CBS. Hancock famous Calver’s invoice was reduced after the media consideration, but it surely shouldn’t take such consideration for a affected person to get an affordable invoice.
Under this laws, either side of the fee dispute would settle their points via an current balance-bill mediation program. The Texas Department of Insurance program has been profitable in reducing medical payments throughout the state.
The laws would beef up this system, which addresses shock steadiness payments better than $500 from all emergency suppliers, together with free-standing emergency departments and all out-of-network suppliers working at a community facility.
“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock mentioned.
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The insurance coverage division’s mediation program, traditionally, had many loopholes and few customers certified for assist. It was expanded in 2017, although, and more patients have been filing complaints.
For instance, in 2014, the division was requested to mediate 686 medical payments. During the 2018 fiscal yr, it obtained four,445 payments.
Hancock mentioned this system, thus far, has saved Texas sufferers $30 million.
Consumer advocates argued the system works solely when sufferers know mediation is an choice, nonetheless.
Stacey Pogue, a senior coverage analyst with the Center for Public Policy Priorities, mentioned sufferers don’t all the time know assist is out there or they discover the method intimidating.
“The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she informed KUT earlier this yr.
She and others have argued Texas ought to undertake a program much like these in states like New York, California and Florida, whose programs are extra consumer-friendly.
Martinez Fischer mentioned it’s time Texas officers step in to assist sufferers who’re caught in the midst of disputes between medical suppliers and well being insurers.
“It has been an industry issue for a few years — I grant you that,” he mentioned, “the health plans and the providers fighting over their business interests, and I respect that. But 10 years later, it is a consumer issue.”
Among different issues, Hancock’s invoice would permit individuals with federally regulated self-funded well being plans to decide into the state’s mediation program. According to Hancock, these plans make up about 40 p.c of Texas’ insurance coverage market, however these customers are presently not ready to participate in this system. Hancock mentioned this could present reduction to customers whereas federal lawmakers weigh their very own efforts to deal with shock medical payments.
“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock mentioned. “Until then, Texas … [is] committed to doing something about it.”
U.S. Rep. Lloyd Doggett mentioned he’s inspired by Texas’ efforts, however referred to as federal protections “essential.”
“Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” he mentioned in a press release.
This story is a part of a partnership that features KUT, NPR and Kaiser Health News.
This story is a part of a partnership that features KUT, NPR and Kaiser Health News.
This story will be republished at no cost (details).
Ashley Lopez, KUT: [email protected]”>[email protected], @AshLopezRadio
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