TX – Law Takes Aim at Surprise Medical Bills from Freestanding ERs

September 2017 ~

In an effort to protecting consumers from surprise medical bills, effective on September 1st, a new state law (SB 507) requires freestanding ER facilities to post notice of which insurance network they are in. The legislation became effective September 1st and expands protections for Texas consumers against the growing practice of balance billing.

Following successful use on a limited basis by consumers in the state, the legislation was designed to expand mediation protections for insured consumers with PPO plans to all out-of-network emergency providers, including all freestanding emergency rooms, and all of out-of-network providers working at a network facility. Mediation is a process by which consumers can challenge surprise medical bills and leave the dispute to the insurer and provider.

This legislation builds on an existing law within in the 84th Legislature that made mediation available to consumers who were balanced billed by six types of facility-based providers (radiologists, anesthesiologists, pathologists, ER physicians, neonatologists and assistant surgeons).

Under SB 507, mediation protections to consumers will be expanded that have a PPO plan to address balance billing through mediation, to all out-of-network emergency providers and to all out-of-network providers working at a network facility.

Mediation of balance bills from all types of out-of-network providers treating patients at in-network hospitals and other facilities, including free-standing emergency departments are allowed under the law as well as mediation of balance bills for emergency care from any provider or facility of emergency care services, including freestanding emergency departments.

Additionally, under SB 507, insurers, facilities and other health care providers must follow specific disclosure requirements regarding network status and balance billing and it is mandated that the statement “This is a balance bill that may be eligible for mediation” be included on balance bills.


Source(s): HealthcareDIVE; Texas Tribune; High Plains Pundit