Proposed Law Could Help Consumers Lower Surprise Medical Bills

By Aparna Zalani | CBS 11 Special Project's Producer

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NORTH TEXAS (CBSDFW.COM) – North Richland Hills resident, Chris Spector ended up at a free standing emergency room in 2015 after a tennis ball hit him in the eye.

“I was given an eye vision test,” he recalled.

But the ER couldn’t help him.

“The physician told me they didn’t have an ophthalmologist on site nor anybody on call,” he told CBS11 News.

Yet Spector still received a bill for $6,100 and his out of pocket expense was $1,100.

“I refused to pay it and they sent my account to collections.”

Spector plans to drive down to Austin on Thursday to tell his story, and share how the new bill SB507 may help him.

SB 507

The new bill SB 507 expands on previous legislation for surprise medical bills. The proposal will help lower bills through the mediation process by the Texas Department of Insurance.

Surprise or unexpected bills happen due to balance billing, which happens when insurers, doctors and medical facilities don’t agree on a cost for a procedure and the patient is billed for the balance.

This includes patients who may have received out-of-network health care unknowingly.

Senator Kelly Hancock (R) of North Richland Hills hopes people like Chris support his new bill on surprise medical costs.

“The one that we are proposing actually expands,” he told CBS11 News.

CURRENT LAW

Under current law, the Texas Department of Insurance will mediate for patients with “out-of- network costs.” The new proposal goes beyond and would help solve issues at free-standing ERs.

There are about 300 free-standing ERs in Texas according to a report by the Center For Public Policy Priorities.

“The biggest loop we are closing is with the emergency room physicians, a lot of these free-standing ERs would qualify in there,” said Sen. Hancock.

If executed SB 507 will:

  • Allow mediation of balance bills from all types of out-of-network providers treating patients at in-network hospitals, free-standing emergency rooms and more.
  • Allow mediation of balance bills for emergency care from any provider or facility of emergency care services
  • Expand disclosure requirements regarding network status and balance billing by insurers, facilities, and other healthcare providers.
  • Providers also must include the disclosure that reads “this is a balance bill that may be eligible for mediation.”
  • Expand mediation protections to the Teachers Retirement System

Right now, the mediation is only for state-funded insurance plans. To check if your plan is state-funded, look on your insurance card for the letters DOI or TDI. If you have those, it is most likely state-funded. It would take an act of congress to include federally funded plans.

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