Chronicle’s “Blindsided” article on surprise medical billing foments outrage in Austin
Published 4:19 pm, Tuesday, November 21, 2017
A Texas lawmaker, angry that patients are being used as leverage when doctors and insurers fight over money, said Tuesday he wants a new law to get consumers out of the middle.
"There's no genuine need for them to be involved," said John Smithee, R-Amarillo, a longtime legislator who is the former head of the House insurance committee and has been on a champion of patient protection against excessively high surprise medical bills.
Smithee joined a chorus of consumer and patient advocacy groups along with health policy experts -- both in Texas and across the nation – outraged by a Houston Chronicle story on Sunday called "Blindsided." The investigation outlined how unsuspecting patients are being financially trapped by a system where out-of-network doctors bill are intentionally staying out of a patient's insurance coverage to bill at a significantly higher rate.
Then any portion the out-of-network bill not covered by insurers can be passed on to patients with a demand they make up the difference. The story showed that such billing occurs even if the hospital itself is in-network.
In Texas, unlike in other states, if patients object they are responsible for starting the mediation process between their doctor and insurer. Doctors said in "Blindsided" patients must be involved because their anger can help extract higher payments to providers during mediation.
"Forcing patients to be in the middle is both cruel and greedy," said Vivian Ho, a health economist at Rice University's Baker Institute of Public Policy. She called it using them as "human shields."
"I would say it is not fair to drag them into it," he said, "They're dealing with two fairly sophisticated parties and they are usually much less sophisticated. There's no reason for them to be there."
He accused both doctors and insurers of "using patients as a bargaining tool."
Florida, California, Illinois and New York have all passed laws to get patients out of the mediation process. In those states, if a patient goes to an in-network hospital for an emergency they are charged an in-network rate regardless of the doctor's insurance status. If doctors and insurers want to dispute the bill they do so separately from patient involvement.
Not all lawmakers, though, were completely on board. Dr. Tom Oliverson, an anesthesiologist and a Republican from Harris County, is wary of any movement to change the mediation process in Texas without a fuller study on how it might affect health care costs.
"You could certainly do that because other states have done it," he said Tuesday, but added, "it is hard to answer yes or now because there are so many unknowns."