Texas Legislature's Fix to Surprise Health Care Bills Still Leaves Millions Vulnerable

Millions of Texans will remain unprotected from surprise medical bills despite state lawmakers this year passing one of the nation's most aggressive pieces of legislation to curb such bills.Senate Bill 1264, signed into law in June and effective Jan. 1, stops patients from being blindsided by exorbitant medical bills for emergency services, services provided at in-network hospitals and other facilities, and for lab work.But the new state law only protects about a third of the 14 million Texans who are vulnerable to surprise medical bills because it only applies to those who have insurance regulated by the Texas Department of Insurance -- usually teachers, state employees, those who work for small businesses and individuals who buy their own insurance.Roughly 9 million Texans, mostly those with employer-funded insurance plans that are regulated by the federal government, are not covered by the law."Consumers are rightly frustrated at the fact they chose an in-network facility or an in-network provider and receive a bill that is hundreds of dollars more than it would have been. We're trying to fix this bait and switch," said Stacey Pogue, senior policy analyst with the Austin-based, progressive Center for Public Policy Priorities.Surprise medical bills are usually high-dollar charges for medical services that patients didn't know were outside of their health insurance network. They happen most often in emergency situations and with anesthesiologists and ambulance rides. A combination of factors are to blame for surprise bills, including the growing cost of health care and breakdowns in negotiations between insurers and physicians.With state lawmakers exhausting almost all avenues to solve the issue, patient advocates are pushing Congress to pass bills that would hold patients harmless for surprise medical bills in emergency and nonemergency situations."I worry primarily about those who work for big employers ... for Dell or any other big electronic manufacturers in Austin," said Ken Janda, a Houston-based health consultant and professor at Rice University. "That is why the activity in Washington is so important, because that will fix the other big piece of the puzzle."  Continue reading...

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