John Bogna
Some Texans are reportedly being surprised after receiving medical treatment at hospitals they believe to be in their insurance network, only to discover the doctors who treated them weren’t.
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In an industry practice called “balance billing,” doctors outside of a patient’s insurance coverage network to set higher rates, a permissible practice by law, then stick the patient with the bill for whatever their insurance doesn’t cover.
According to the Houston Chronicle, this often happens in emergency care situations, where a patient doesn’t know, and is left with no choice over, who provides treatment.
Even if their hospital is within their provider network, if the doctor who treats them is not, they could be responsible for thousands in expenses.
Over the past decade, Texas health policy analyst Stacey Pogue studied this loophole, and she said the data she’s seeing suggests the pricey trends are no coincidence:
“It’s a system totally rigged against patients,” Pogue said in an interview. “They can’t win. Instead of resolving the dispute, they just push the cost onto the consumer.”
There is a mediation process in place to help people with these surprise bills, but it is reportedly difficult for the majority of Texans to access.
Currently, patients must figure out their medical bills to determine whether the expenses qualify for mediation and apply for it.
Even so, legal loopholes still exempt some bills from mediation under Texas state law.
You can read the Texas Center for Public Policy Priorities’ report on surprise medical expenses, Legislators’ attempts to introduce bills to reconcile the sometimes-costly issues, and what some advocacy groups are working to do about them here.
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