There has been a huge drop in the number of Texans calling state regulators over surprise medical bills in the past six months.
A new law went into effect at the beginning of the year requiring medical providers and insurance companies to figure out payment disputes themselves – instead of sending bills to patients.
Senate Bill 1264 applies to Texans with state-regulated health insurance plans and people who get coverage through the state employee or teacher retirement systems, which is about 20% of Texans. It prohibits providers from billing patients for the difference between what a medical service costs and what the insurer will pay. Balance billing had become a particular issue for patients who ended up in out-of-network hospitals after a medical emergency.
Now, there are options to resolve these payment disputes.
Stephanie Goodman, a spokesperson for the Texas Department of Insurance, says consumers probably didn’t even notice the change, because these bills are no longer their problem.
“We have seen a tremendous decline – more than 90% – of complaints from consumers about balance bills,” she said. “So that’s great news for Texas.”
According to a TDI report to the state Legislature, insurance regulators have received “19 consumer complaints about balance billing in the first six months of 2020, down from 546 for the same period in 2019.”
The agency is also reporting a dip in complaints from medical providers about payments. Goodman said those complaints are down more than 70% from the same period a year ago.
“Before SB 1264, consumers could request mediation for certain surprise bills, but the only recourse available through TDI for providers seeking to resolve billing disputes was to file a complaint,” the agency wrote in its report. “TDI received 1,770 complaints from health care providers and billing services in the first six months of 2020, down from 6,461 for the same period in 2019.”
While the report is only a snapshot of the first six months of the law’s implementation, there have been a few trends that have cropped up. Goodman said, for example, an overwhelming share of dispute resolution requests are coming from emergency room staffing and billing firms. These firms made up about 10% of requests in the old system, but have made up 85% of requests in the past six months.
“We may be seeing skewed results because of the COVID effect,” she said. "That may largely be due to the ban on elective surgeries that you have had for part of the six months. But this is very preliminary information.”
Goodman said the agency will be providing more information to the state Legislature later this year, which would include more data.
Regardless of whether a Texan has a state or federally regulated plan, Goodman said, they should contact TDI if they receive a surprise bill. She said her agency can point consumers to the appropriate agency to address the issue.
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