by jerry on June 23, 2019
Kaiser Health News published an article describing how Texas recently passed legislation to protect patients from surprise medical bills, a topic of recent interest. Patients can be surprised by medical bills even when they go to an in-network facility, since that facility might employ or consult an out-of-network physician. While the state government does not mandate prices, the new legislation appears to require that the hospital and the insurer settle their disputes without involving the patient.
This protection seems quite reasonable in that once a patient has checked whether a facility is in-network (or not, in the case of an emergency), the patient has done what s/he can to minimize costs. That a hospital is unable to verify before the procedure that all involved providers are in-network or that an insurer was unwilling to establish an agreement with emergency providers in the area seem to fall within the responsibility of the providers and insurers, not the patient. The article reports that more than a dozen states have enacted some legislation or regulation against surprise medical billing, and some have suggested that the federal government may eventually take up the cause.