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Apex IONM Solutions Apex IONM Solutions

Balance billing is bigger in Texas

By Admin | February 08, 2017

When a patient has been treated at an in-network facility, but an out-of-network doctor treats him, that patient will most likely find himself the financial victim of balance billing, a nationwide problem that is more prolific in the Lone Star State.

It means providers hold patients responsible for charges their insurance companies refuse to pay, which negates the purpose of having insurance in the first place.

Since 2015, patients with bills over $500 could request mediation between insurance and providers to help alleviate some costs, but most patients were unaware of this option.

Texas lawmakers are attempting to make the option more known and transparent by having instructions printed directly on bills. However, the mediation process only applies to those who have a major-medical preferred provider organization health plan. Anyone with government-run, self-funded, or retirement and health maintenance organization plans are excluded. Some facilities and providers are also excluded.

The Affordable Care Act, ACA, also offered some protections for patients who may find themselves in out-of-network emergency rooms.

Why is this a bigger problem in Texas? Between 21 and 56 percent of hospitals who take the state’s three largest insurance providers do not have in-network doctors on their emergency staffs.

For more, read “Medical billing is a national problem that's even a bigger headache in Texas” by Dallas News.

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