Texas Legislature Puts Stop To Surprise Medical Billing

Recently, the Texas Legislature signed Senate Bill 1264 into law, which was supported almost wholeheartedly by state representatives and senators on both sides of the aisle. According to NPR.org, the Lone Star State is the most recent of roughly a dozen states to have signed legislature against unjust, surprise medical billing practices.

Greg Abbott, the Governor of Texas, eagerly signed Senate Bill 1264 into law on Friday, June 14, 2019, which effectively blocked medical service providers from sticking patients with bills that neither the providers nor patients’ insurance companies could agree on paying. In most cases where insurance and medical service providers can’t agree on payment, patients end up getting hit with huge bills that they almost always can’t afford.

Now, thanks to Senate Bill 1264, insurance companies and medical service providers are able to freely enter the process of arbitration, in which Texas state-level officials are responsible for overseeing, ensuring that nobody gets stuck with bills that are simply ridiculous.

Experts indicate that the practice of surprise medical billing usually results from visits to hospitals’ emergency departments in which the hospitals they visit are out of their insurance providers’ network. Insurance companies typically cut deals with a palette of hospitals and physicians’ offices to bring them under their networks, where people covered by those insurance companies are able to exercise their insurance policies. When push comes to shove and people find themselves in emergency situations, the last thing on their minds is whether their insurance providers consider nearby hospitals to be in-network or not.

Analysts and other people with experience in the field also state that another general situation that often results in surprise medical billing is when people visit in-network hospitals and the individual doctors aren’t actually in those patients’ insurance policies’ networks.

Take, for example, Drew Calver of Austin, Texas. Calver, a high-school teacher, suffered a heart attack two years ago and had a close friend carry him to a nearby hospital. In emergency surgery, physicians placed stents in Calver’s heart. Though Calver’s insurance covered part of the bill, some $55,000 of it, he was still stuck with a bill totaling a whopping $108,951. Talk about a surprise medical bill!

A 2018 survey conducted by the Kaiser Family Foundation reported that some two-thirds of people across the United States worry about surprise medical bills. The Texas Legislature’s decision has been supported by virtually all Texans – but maybe not insurance companies and medical providers.