It is most disheartening when what seems like a victory begins to look like a defeat. All it takes is creative rulemaking, and the best intent of lawmakers on behalf of citizens can be turned on its ear.
Last spring, Texas lawmakers came together in a bipartisan effort to protect consumers in state-regulated health care plans from getting hammered with outrageous bills for out-of-network treatment. Among its many reforms, Senate Bill 1264, which Gov. Greg Abbott signed into law, authorized an arbitration process for insurers and providers to work out their billing differences.
The idea was to prevent patients from being held hostage and ultimately getting stuck with the bill.
However, the Texas Medical Board, the state agency mandated to regulate medical practices, wants to expand a provision in the law that would allow consumers to opt for higher costs if they willingly use an out-of-network doctor for nonemergency care. The medical board’s proposal would extend the narrow exemption to include all out-of-network providers — like anesthesiologists and pathologists — if a patient signs a waiver.
Consumer groups and Lt. Gov. Dan Patrick rightly blasted the Texas Medical Board for encouraging a raft of misleading paperwork that could expose patients to receiving bills for whatever costs that insurers and providers did not pay. In other words, consumers would be back in the middle.
“After passing the strongest ‘surprise billing’ protections in the nation, I am not happy to learn that attempts may be being made at the Texas Medical Board to create a loophole to undermine this important law,” Patrick said in a statement. “Senators are not happy either.”
The Texas Medical Board says there is no attempt to mislead and it would provide patients with enough advance notice to avoid billing surprises. Nonetheless, a loophole by any other name is still a loophole.
The whole point of SB 1264 was to remove patients from being collateral damage in billing disputes. It barred surprise medical bills from being sent to patients who have been treated by out-of-network providers when the treatment is an emergency and clamped down on stunning charges for medical out-of-network care at in-network hospitals and out-of-network lab and imaging work.
Texas lawmakers made clear that they wanted consumer protections to reduce the paperwork jungle and the prospect of patients making expensive missteps.
The clock is ticking. The board will review the rule and public comments at a meeting this month and could direct staff for revisions. The rules need to be in place by Jan. 1.
A surprise medical bill is every patient’s financial nightmare. Lawmakers took important steps to help patients, and the will of the Legislature should be upheld.
