New Report Shows Surprise Medical Bills Taking Toll on Texans

Most of us will end up in an emergency room at some point.  And when we do, we’ll probably have no choice which physicians treat us and no ability to ensure they are part of our insurance Screen Shot 2014-09-15 at 2.53.10 PMcompany’s network of preferred providers.

As Texas consumers, we may reasonably expect that if treated in an in-network hospital in an emergency, the doctors practicing within that hospital would also be in that same network. This is too often not the case, leaving us vulnerable to surprise medical bills, known as “balance bills,” from out-of-network physicians based at hospitals.

Our new report, Surprise Medical Bills Take Advantage of Texans, analyzes data from Texas’ three most popular insurers: Blue Cross Blue Shield, Humana and United Healthcare. According to the analysis, it is common for Texans who receive care in an in-network emergency room to receive treatment from an out-of-network doctor. There are some hospitals, in fact, where zero emergency room doctors at the facility are in-network under the popular insurance plans accepted by that hospital.

The report outlines several policy recommendations that could improve medical price transparency. These include protecting consumers in emergencies, when they can’t select their provider, by guaranteeing that they receive in-network rates at in-network hospitals.

Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.

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One response to “New Report Shows Surprise Medical Bills Taking Toll on Texans”

  1. Flora Brewer says:

    We were balance billed this summer and have been threatened by the provider with referral to a collection agency if we did not pay immediately. My husband snipped off the end of his finger while doing yard work in June. He went to a nearby hospital that is listed as an in-network provider by our insurance company where they sewed on the end of his finger. We had met our deductible and owed nothing according to our insurance company. We were surprised when we were billed by the hospital under a different name for a balance of over $400. I called the insurance company who explained that we did not owe this amount but that the insurance company would pay if the provider, which was billing under an entity that was out-of-network, continued to try to collect, even though it was for emergency service. I was assured that the insurance company would pay, but we continued to get bills from the provider and ultimately a threat of referral to a collection agency. This article is a wonderful illumination of a real problem facing Texas consumers. Good work!

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