Texas new surprise-billing legislation leaves out employer-sponsored insurance

Texas legislation to address surprise medical bills will not protect millions of state residents who work for companies who operate employer funded health benefit plans, according to the Austin American-Statesman.

Numerous states have enacted laws to protect patients from surprise medical bills at out-of-network provider sites in emergency situations or at in-network hospitals when services are rendered by out of network independent providers.

The  law signed by Texas Gov. Greg Abbott June 14 takes effect Jan. 1. It includes arbitration as a means to resolve out-of-network payment disputes between providers and insurers and sets limits on negotiated rates, according to Reform Austin, a website providing nonprofit journalism.

Under the law, surprise medical bills are prohibited in circumstances where patients are unable to choose the provider they see or the facility they visit, said one of the bill’s authors, Sen. Kelly Hancock, R-North Richland Hills. This includes medical emergencies, out-of-network care at in-network hospitals and out-of-network lab and imaging work.

But the Statesman reported that the law does not cover about 9 million Texans who don’t have insurance regulated by the state’s insurance department.

People who have health benefits regulated by the state are typically teachers, state employees, small business workers and people who purchase their own coverage, according to the newspaper. Residents the law doesn’t apply to are mostly people with employer-funded coverage regulated by the federal government under ERISA and the Taft Hartley Acts.

The Texas law comes as Congress works to stop surprise medical bills at the federal level. Congress reconvenes in September.

But if the employer chooses to make SurgeryShopper’s convenient and transparent shopping tool and its pre-qualified providers and facilities available to employees, everyone saves and surprise bills are essentially eliminated.

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