Local Lawmaker Introduces ‘Landmark Legislation’ to Fight Surprise Medical Billing in Texas

Local Lawmaker Introduces ‘Landmark Legislation’ to Fight Surprise Medical Billing in Texas: North Texas State Senator Kelly Hancock authored Senate Bill 1264 to address surprise billing in the state, prohibiting out-of-network providers from sending surprise bills when patients don't have a real choice of provider. The bill will make patients responsible for applicable co-pays, coinsurance, and deductibles with no additional charges after mediation between the provider and health plan. Data from the Texas Association of Health Plans says that 30 percent of all ER physician services are out of network, even though 65 percent of those services occur at hospitals that are in network. Freestanding emergency rooms account for 83 percent of all out-of-network emergency room services, resulting in $3 billion a year in avoidable costs. Excluding freestanding emergency rooms, 94 percent of out-of-network physician claims for emergency services occur at network hospitals. TAHP's findings show that nearly half of all ER physician claims are out network, which is much higher than other