Reducing ‘surprise bills’ for emergency room patients

Hospital bed (KXAN Photo)
Hospital bed (KXAN Photo)

AUSTIN (KXAN) — When Miriam Moorman began her quest to cure a swollen knee, it was the beginning of a long, expensive journey. She started with her general practitioner, asking the doctor to refer her to a specialist for insurance purposes.

Instead of referring Moorman to a specialist, the doctor decided to treat her by draining her knee and giving her a steroid shot. Moorman, who’s not good with needles, briefly passed out. But she told the doctor all she needed was some rest.

“[The doctor] kind of freaked out, really. She stuck me in an ambulance and sent me to the emergency room,” remembers Moorman. “No one seemed to listen to me that I didn’t need to have this.”

Feeling unheard was just the beginning of her problems. A few weeks later, an $8,800 bill arrived in the mail, the price tag after insurance.

“A lot of it was out-of-network, so my insurance wasn’t going to cover it,” said Moorman.

“Surprise bills” can happen when a person insured under a preferred provider organization (PPO) unexpectedly receives services out of network.

“For instance, I as an orthopedic surgeon come to the emergency room because you need help and I’m on call, I’m out-of-network. You wake up after I help save your leg and you get a big bill. And your insurance company doesn’t want to pay the full amount because it’s an out-of-network benefit,” explains Dr. David Teuscher.

A Texas law passed in 2010 gave patients the right to request mediation for certain out-of-network providers: radiologist, anesthesiologist, pathologist, ER doctor, neonatologist and assistant surgeons.

Now lawmakers want to expand the mediation process to all out-of-network health care providers at an in-network facility along with emergency care, rather than just hospital-based physicians. It would include more health care providers in the mediation process, along with freestanding emergency rooms, to provide more patient protections from narrow insurance networks.

Dr. Teuscher testified in favor of House Bill 1566 to the Insurance Committee on Tuesday.

“Any physician that happens to be out-of-network, guess what? You’re going to get protections under this process. You’re going to get treated fairly through a mediation process, should you choose to have that,” said Dr. Teuscher.

The Texas Medical Association supports the bill and says 95 percent of mediation cases are resolved before going through the full process, saving patients money.

When the mediation process first began in 2010 there were 14 requests. Last year there were over 1,600.

Moorman believes it’s a good start to amending the system.

“Somebody needs to stand up for patients and we as patients and potential patients need to stand up and demand that some changes get made,” said Moorman.

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