Person finding a surprise medical bill in the mailbox

A Texas-Sized Problem:

How to Limit Out-of-Control Surprise Medical Billing

By Stacey Pogue, updated 2/21/2017

Surprise medical bills happen when insurers and doctors or other health care providers – fighting over prices – jointly pass the buck to a patient, who received out-of-network health care unknowingly. Surprise billing is especially common in an emergency –  when sick or injured patients must rush to the nearest emergency room and have no ability to choose the doctors who treat them. Our new report shows that Texas patients are routinely treated by out-of-network doctors at in-network hospital ERs. A staggering share of Texas hospitals do not have even a single in-network emergency room physician for one or more insurers who cover the hospital, guaranteeing that emergency treatment will be performed by out-of-network doctors for many patients. Scroll down to find out more or click "full report" to see all of our findings.


1

Image of an ambulance driving under a cloud

In a medical emergency, patients must rush to the nearest emergency room. Patients can’t “shop around” to find doctors and ERs in their insurer’s network.

2

Image of a hospital with a little helicopter flying over

Patients unknowingly get health care that is outside of their insurer’s provider network.

3

Image of people fighting over medical bills

The insurance company and out-of-network doctor or other health care provider fight over the bill. Doctors charge high prices and insurers pay low rates. Instead of resolving their disagreements, they off-load the cost onto the patient.

4

Image of a mailbox getting a medical bill

The patient, who is recovering at home, gets hit with a surprise bill—big out-of-network charges on top of the expected deductible and copays.

5

Image of people climbing over a barrier

Texas technically has a mediation system to address some bills, but the complicated steps required just for patients to begin mediation, prevent many from benefiting.

6

Image of the Texas Capitol with clouds behind it

Other states have systems to address surprise bills that don’t place hurdles in front of patients. The Legislature should protect all Texans who have had an emergency from surprise medical bills. Insurance companies, doctors, hospitals, and other health care providers should be the ones to initiate mediation and use Texas’ system to reach agreement on prices.

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