New Law Targets Out of Network Billing Charges by Freestanding ERs

Some patients who visit emergency rooms are surprised when they get their bills in the mail because they have been a victim of unexpected out of network billing. A new Texas law is attempting to prevent this from happening to more patients.

When patients must utilize emergency room services, often they are unaware if the emergency room they are visiting is within their insurance plan network. If it is not, or if a particular doctor is not in their network, the patient can be hit surprise out of network billing.

However, a new Texas law that took effect on Sept. 1 is attempting to inform patients about whether or not emergency services are covered. According to the Texas Tribune, this new law requires freestanding emergency room facilities to post what insurance providers they take so that patients know whether or not the services are covered.

Texas became the first state in 2009 to allow emergency rooms to operate freestanding from hospitals. These are not urgent care clinics, but can provide emergency care around the clock. They often do not have agreements with insurance providers, and thus they sometimes charge patients very high rates for services.

The Texas Tribune notes that “[t]hey have spread quickly across the state, profiting, their critics argue, by charging up to ten times more than urgent care centers to treat ailments like a fever or sore throat. These prices have blindsided unsuspecting consumers who realize too late that they were treated by an out-of-network provider.”

For example, a Texas man was charged $1,100 in out of network billing following a trip to a freestanding emergency room. He was seen for an eye injury. After tests, they referred him to a nearby ophthalmologist.

According to this patient, the ER charged his health insurance for the full $6,111 for the visit. United Healthcare paid over $4,000, but he was still billed over a thousand dollars for his one ER visit. This patient asserts that the out of network billing charges are “unreasonable, uncustomary and even predatory.”

Indeed, when he visited the ophthalmology center the following day, he received more comprehensive care, he says, for a fraction of the cost.

This law is intended to protect customers from being surprised by out of network billing charges. Often patients think that these freestanding emergency rooms are similar to urgent care clinics with similar pricing. Under this new law, facilities can post the insurance information on their websites, but if they only post it online, they must also provide this in written form to patients.

State representative Tom Oliverson, R-Cypress, authored this new bill and he has said that most freestanding emergency rooms are not intentionally misleading people. However, he believes this new law will help make the system less confusing for patients.

An additional Texas law also looks at the fairness of out of network billing for patients of freestanding emergency rooms. It provides for a mediation system for patients when they dispute surprise emergency room bills and medical bills.

If you have been surprised with out of network billing charges, you may benefit from speaking with an experienced attorney.

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