New Texas legislation protects health care consumers

While much was discussed and debated during the 85th Texas Legislative session, two important and successfully passed bills will help protect Texas healthcare consumers from the outrageous costs and confusion associated with freestanding emergency rooms.

Senate Bill 507, authored by state Sen. Kelly Hancock, expanded mediation protections for PPO insurance plan holders to include freestanding emergency rooms as well as other out-of-network emergency providers. That reform empowers Texans with PPO coverage to challenge the overly expensive medical bills they received when visiting one of these facilities.

Another important victory for patients was House Bill 3276, authored by state Rep. Tom Oliverson. It requires independent freestanding ERs to be more transparent when it comes to their insurance network status. Often, patients are confused about the cost of services these facilities cover and about what’s considered in-network.

The Legislature also mandated that the Employees Retirement System of Texas implement measures to reduce participants' use of out-of-network independent freestanding emergency rooms.

Our elected officials are to be commended for these significant reforms, which will not only help protect patients against egregious charges for health care, but are meaningful steps to end behavior that took advantage of those who are unaware and in need during acute or emergency health events.

As a physician, I understand why patients want to be equipped with information not only about where they should go in an emergency, but also what it will cost. That’s why Blue Cross and Blue Shield of Texas (BCBSTX) has pushed for cost transparency from freestanding emergency rooms. In 2016, BCBSTX contacted all known out-of-network freestanding emergency rooms in Texas to invite them into our network. The goal is to protect our members from surprise billing and ensure reasonable costs for the services freestanding emergency rooms provide. Notably, in response to that outreach, not a single facility chose to contract with us.

At BCBSTX alone, nearly 70 percent of total out-of-network claims stemmed from freestanding ER visits. Thanks to HB 3276, Texans will now have to be informed about whether the facilities they are visiting are in-network or not.

We are committed to helping our members and Texans receive quality, cost-effective care. That starts and ends with being good financial stewards of our members’ dollars. While we want our members and Texans to have convenient access to a wide choice of potential providers — including emergency rooms and urgent care centers — we also must ensure they are clear about the differences and the associated costs.  

Why is it important that patients know the difference between an urgent care center and a freestanding ER? On this confusing issue alone, BCBSTX claims data indicates there is a 75 percent overlap in services our members tend to receive at both the free-standing ERs and urgent care centers in Texas. In other words, approximately 75 percent of the patients in our network who sought care at freestanding ERs for medical issues could have received treatment at  far more economical urgent care centers.

Take bronchitis as an example. If a patient suffering from typical bronchitis symptoms visits a Texas freestanding ER, the bill would be $2,944. By comparison, the same diagnosis and treatment at an urgent care center would be $167, or $136 at a traditional doctor’s office.

That’s why we advocated for and strongly supported these reforms. And while we are pleased these bills passed, our work is not done. The cost of healthcare continues to grow at an unsustainable rate in Texas, and more work is required by legislators, providers and insurance companies.

For our part, we will continue providing our members with resources to help them be more informed consumers so they will know where they go for medical services matters. We also want our members to understand their emergency care options before they need them.

We will continue advocating for solutions that drive down healthcare costs, promote greater access and increase transparency. These new reforms demonstrate solid progress in protecting our members, and all Texas healthcare consumers. It’s part of the work BCBSTX has been doing for nearly 90 years to provide our members access to quality, cost-effective health care. Our members, and indeed Texans, should not expect, nor accept, anything less.