May 19, 2017
AUSTIN—The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today applauded Senate passage of Rep. Tom Oliverson’s HB 3276, which requires independent freestanding emergency rooms in Texas, which are almost all out-of-network for insured Texans, to be more transparent and upfront with patients about their network status. HB 3276 now heads to the Governor for his signature.
“With health care costs rising across the board, more than ever Texans deserve greater transparency and more information to make the best health care decisions for their families, their medical needs, and their budgets. Freestanding ERs pose the biggest concerns for confusing advertising, scant details, out-of-network care, and exorbitant pricing. We applaud Rep. Oliverson and his fellow legislators for taking an important step today to hold freestanding ERs accountable and better equip consumers so they can make more informed decisions and protect themselves against surprise medical bills,” said Jamie Dudensing, TAHP CEO and a former practicing nurse.
HB 3276 would:
- Help consumers know if a freestanding ER is in their health plan’s network by increasing disclosure requirements of network status at freestanding ERs.
- Require these facilities to tell Texans explicitly if they are in the patient’s health plan network or not in their health plan network.
- Require freestanding ERs to post a notice that informs patients if the facility does not participate in any health plan network.
Background:
Texas is home to more than half the nation’s population of freestanding ERs (FSERS), which largely choose to remain out of network, allowing them to charge up to 10 times more than similar urgent care centers. FSERs often mislead consumers by telling them they “accept” their insurance, when in reality most are not in their insurance networks. In their recent editorial “Billing abuses at standalone emergency care centers are costing Texans a hefty chunk of change,” the Dallas Morning News editorial board wrote: “Consumers shouldn’t be stunned with predatory charges when they make a health care choice…Some freestanding emergency rooms even tell patients that their insurance will cover the procedure when they know that the facility or the doctor are not in the health plan network. Such misleading behavior is unconscionable.”
- There are more than 200 FSERs in Texas – more than half the nation’s population of these facilities.
- Freestanding ERs pose the highest risk or surprise medical bills for Texans and are responsible for nearly 70 percent of out-of-network emergency facility claims in Texas.
- Charge for treating a cough at a freestanding ER: $3,044. Treating a cough at an urgent care center: $180.
Read more about the emergency care cost crisis in Texas, along with background on freestanding ERs and how they use misleading advertising, charge exorbitant prices, and refuse to go in network:
- Emergency Care Cost Crisis in Texas
- Fact vs Fiction on Freestanding ERs
- Buyer Beware: Telling the Truth About Freestanding ERs
- TAB Guest Column, Texas Tribune: Outsized freestanding ER Costs tying the hands of Texas employers
- Dallas Morning News Editorial: Billing abuses at standalone emergency care centers are costing Texans a hefty chunk of change
- $2500 Bill for Benadryl & a 15-Min Visit
- $6000 Bill for a Referral Due to ‘Lack of Expertise’
- Rice Univ. Health Economist Discusses Freestanding ERs
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The Texas Association of Health Plans
The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.
