New law aims to remove patients from billing disputes between health plans & doctors

Posted at 6:23 AM, Jan 06, 2020
and last updated 2020-01-06 10:43:27-05

CORPUS CHRISTI, Texas — The high cost of medical care is giving some Americans sticker shock. Annual health care spending in the U.S. is estimated to be $3.5 trillion.

Hospital costs make up almost a third of that total.

And a portion of those costs come as a big surprise.

Lawmakers passed Senate Bill 1264 to protect patients from paying any other cost greater than what their health care plan requires.

“This is good news for the consumer and for those that are insured in Texas because the surprise medical bill act would prevent out of network insures. Say your insurance did not cover you, and you were in an area where you were out of network, you would be hit with these outrageous bills. This prevents that,” local attorney Joe Flores said.

Whether intentional or due to careless mistakes, “surprise” medical charges are common.

“Well, it sends a strong message that Texans are tired of paying huge amounts on their hospital bills, medical care, and it does place an effective cap on how much people would pay if they are out of network. The network could be just in their area and their providers and their doctors so that at least puts a stop gap measure on people paying out of control expenses,” said Flores.

The law aims to remove patients from billing disputes between health plans & doctors, but it only applies to the 16% of Texans with state-regulated health insurance.

“The bad news is that it does not completely protect you; you may still get these co-pays and out of network expenses. But not as they were out of control where people would need to to ask for an accounting of what happened because they were getting these huge bills, ” said Flores.

If you believe you’ve been treated unfairly, file a complaint with the agency that regulates your provider or health plan.

“So especially out of network, I would strongly recommend that people ask for their billing and look line by line to see if they were charged or things were not covered and work with your insurance company. Also work with the hospitals, and if you don’t get results, you report them to the appropriate agency, such as the Texas Department of Insurance,” said Flores.

Texas now has one of the strongest laws protecting patients from surprise medical bills.

This was a big win for the consumers, and it was a long time in coming. This will give consumers the greater right to ask about billing, why services were provided, and why they were billed in a certain manner.