Mediating Out-of-Network Hospital Services
Before January of 2020, an insured person who went through an emergency room of an out-of-network hospital facility was usually responsible for the total charges less any payment made by their out-of-network insurance carrier. The difference could be an exorbitant amount for the patient who had no choice in emergency room services. Not only was the patient responsible for the co-insurance, co-pays, or deductibles, but they were also responsible for any balance the insurance did not cover…SURPRISE! Note that the financial responsibility also applies to other out-of-network medical providers, such as anesthesiologists or emergency room doctors.
Senate Bill 1264 aims to protect patients from receiving surprise hospital bills that make them responsible for amounts greater than the deductible, co-insurance, and/or co-pays. It is called balance billing for the balance left after insurance and consumers are protected in Texas from this surprise cost.
Texas requires insurers and healthcare providers to mediate the cost for out-of-network services before billing patients. If a patient gets a bill from an out-of-network hospital (or other healthcare providers) that is beyond their deductible, co-insurance, and or co-pay, they can demand the parties to mediate that cost before billing them.
The Texas Department of Insurance has provided consumers with help concerning provider's balance billing patients.