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Editorial: Good bye to billing surprises


The coronavirus relief package passed at the end of last year by Congress and signed by the president extends help to a wide cross section of our society. The $600 stimulus checks that most families received are inadequate but helpful, as is the extension of the $300 per week unemployment stipend. Another aspect of the new legislation, which impacts fewer Americans but in many cases more severely, is the limitation on surprise medical bills that land when a patient receives services that are not in their insurance network.

Legislation approved by Texas lawmakers in 2019 provided relief from many sources of surprise medical bills, such as those that occur when an out-of-network provider becomes involved in a patient’s care. An example is a patient who goes to a hospital that accepts their insurance but ends up being treated by an ER doctor who doesn’t.

A particularly painful source of surprise billing, air ambulance services, is addressed in the new federal measure, which prohibits providers from charging patents for services at a rate that is more than the in-network cost-sharing amount. Furthermore, the legislation stipulates that patients are only required to “pay the in-network cost-sharing amount for out-of-network emergency care, for ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patent’s informed consent.”

Payment disputes are to be resolved between providers and payers, with a 30-day negotiation period to settle out-of-network claims. If a resolution is not achieved, the parties would move to binding arbitration overseen by an independent arbiter.

Not surprisingly, the bulk of surprise bills arise when patients are not able to select their providers, which is almost inevitable in the case of ambulance services, whether by ground or air. We have all heard of the $20,000-plus cost of an air ambulance trip from our area to San Antonio.

Fortunately, those charges have been addressed, but we would encourage the 87th Texas Legislature to also consider fees for ground ambulance services. They, too, should fall under the same guidelines as other emergency care. That is to say, billed at the in-network rate.

Sadly, the federal legislation does not go into effect until 2022, but at least in Texas we have some existing protection from surprise medical bills.