Sen. Hancock introduces surprise billing legislation

Senator Kelly Hancock and Representative Trey Martinez Fischer announced new legislation to address surprise medical billing on Thursday morning. The new bill builds off of legislation introduced by Hancock 10 years ago which established a mediation process through the Texas Division of Insurance (TDI) for patients to dispute certain surprise balance bills.

Hancock’s new bill expands on the established mediation process which, according to Hancock, has already saved Texans millions of dollars.

“When it’s available and used, we can confidently say that surprise bill mediation has saved Texas patients well over $30 million in out-of-pocket health care expenses,” said Hancock during the press conference announcing the bill. “Still, thousands of Texans receive unexpected and, frankly, unreasonable surprise medical bills every year.”

The legislation prohibits providers from balance billing patients in several instances. These includes when patients are treated by an out-of-network provider in an in-network hospital, as well as in instances where patients receive care from a non-network provider or non-network facility in an emergency situation.

“Like the current mediation system, this is designed to apply in situations where patients don’t have any choice which facility they go to or which physicians are involved in their care,” said Hancock.

However, in these instances the patients are still responsible for their copayment, coinsurance, or deductible amounts based on their chosen health plans.

Previously, patients were responsible for initiating the mediation process. But with the new bill, providers would be allowed to trigger mediation.

“Why should patients get caught up in the middle,” asked Martinez Fischer during the press conference.

Another key change to the mediation process through this bill is the inclusion of ERISA plans. According to Hancock, these plans make up at least 40 percent of the Texas health insurance market, and the new bill would allow ERISA plans to utilize the mediation process.

“It’s our hope that by including these plans in mediation, Texas will send a loud and clear signal to [Washington] DC. That similar consumer protections need to be passed at the federal level,” says Hancock.