The powerful Texas Medical Association has come out swinging in its opposition of proposed bipartisan legislation that seeks to end surprise emergency room billing in the state.
The lobbying group that represents 53,000 doctors in the state began blanketing lawmaker’s offices with a flier this week demanding legislators instead “hold health insurers accountable for the products the sell to Texans.”
On Feb. 28 state Sen. Kelly Hancock, a Republican from suburban Fort Worth, introduced sweeping legislation that would treat all emergency room visits as in-network and bar doctors from billing patients for any portion of a charge that insurance does not pay. In addition it would protect unsuspecting patients who go to an in-network facility, such as a hospital or surgical center, and later discover they were treated by an out-of-network provider.
Texas Medical Association has contended surprise billing is not the fault of doctors, but rather insurers who severely limit networks and refuse to allow willing physicians into networks. The group also accuses the insurance companies of under-paying them and arbitrarily denying legitimate claims.
“Some of the most frequent, and most irritating intrusions into physician’s daily lives come from health insurance companies,” the flier said. It further stated that “we strongly oppose” Hancock’s proposed legislation, calling it mere “window dressing” to protect patients.
The medical group said the law would allow health plans to “determine unilaterally what they pay for care provided out of network” and lets insurers “skirt responsibility for the products they sell.”
Hancock, who for the past decade has battled against surprise billing, said in a statement: “It’s a shame the association chose to take a staunch position against patient protections instead of working with us on the bill.”
Texas has one of the worst records of surprise medical billing in the nation. Internal claims data from the three largest insurers in the state shows that two of three emergency physician claims in 2017 occurred at in-network facilities.
The measures introduced by Hancock and Martinez Fischer would also remove patients from the middle of billing disputes between doctors and insurers under the state’s mediation process. Patients would only pay in-network rates for such things as deductibles and co-pays. If doctors believe they have been wronged by insurers it will be up to them to start mediation, not the patients.
While many Texans remain ineligible for the mediation process, the proposed legislation would allow some to opt-in.
Previously, the Texas Medical Association has said it opposes removing removing patients from the mediation process because they can help influence insurers to pay more.
The medical group, in its flier, said it does support other legislation introduced this year that takes aim at health maintenance organization (HMO) plans that require prior authorizations for certain treatments. Other legislation the group supports would require insurance directories for in-network doctors to be updated every two business days and force the Texas Department of Insurance to review network adequacy requirements at least every two years.
There is little doubt a fight over patient billing is building in Texas. After Hancock’s bill was unveiled last week, Gov. Greg Abbott tweeted: “Sweeping legislation takes aim at shock emergency room bills in Texas. This issue must be resolved this session.”