This past winter a bill was proposed to the Texas House that would transform the way that freestanding emergency rooms were treated under the law. Growing concern surrounding the way these facilities operate and their surprise billing practices pushed the bill successfully through the house.
That bill is Texas HB 2041.
Surprise billing is a common practice among this type of patient care facility, if for no other reason than it was simply acceptable. However, now under the new legislation, those old practices would be a thing of the past.
Patients use freestanding emergency rooms, also known as urgent care facilities, to receive fast care in emergency situations. Some data indicates that the most common ailments they treat include upper respiratory infections, ear problems, skin conditions, and back problems.
The problem with using freestanding emergency rooms is confusion over what insurance is accepted, what treatments are covered, and ultimately how much more they charge than a standard emergency room.
This bill has become a hot topic surrounding Texas healthcare, but it is one worth discussing. With the recent passing of HB 2041, it’s important to understand what it covers, why it was needed, and how it can benefit the everyday patient.
The History of Freestanding Emergency Rooms in Texas
One of the biggest issues regarding freestanding emergency rooms in Texas is the fact they are rarely covered or in-network for patients. However, marketing efforts by the facilities contribute to confusion making it difficult for many patients to understand they will be required to pay out of pocket for treatment. This leads to surprise billing, thanks to a lack of transparency on the part of the facility. At times, the logo or name of popular insurance providers like Blue Cross Blue Shield was used as signage on doorways. Representatives claimed that this was, in a sense, false advertising. This was partly responsible for the passing of the bill.
Another issue with Freestanding Emergency rooms is the language they use. For example, most of these facilities used words like ‘take’ and ‘accept’ insurance, when that has very little to do with actual coverage. It also fails to take into consideration the ‘in-network’ requirements of most insurance providers. To showcase this flaw in the freestanding emergency room facility process, AARP contacted over 200 of them to see their response to the in-network insurance question. According to their research, over 70 percent of these facilities claimed they accepted or ‘took’ insurance on their website. After contacting them, it was discovered that only about 60 percent actually did, in fact, accept insurance. It’s discrepancies like this that put many patients on the receiving end of a surprise bill.
But what makes paying out of pocket so bad for patients? Overpriced medical services. Unlike emergency rooms that regularly take insurance from patients, freestanding emergency rooms are out-of-network and the prices they charge for basic medical procedures are far higher. Why? Because of emergency department facility fees. These are fees that emergency centers are able to charge for offering emergency care. However, there is much debate over whether freestanding emergency rooms should be allowed to do so since most of their care is for non-emergency situations.
Texas HB 2041—A Legislative Win
Thanks to the concern of many patients, and countless Better Business Bureau complaints, a law was proposed to change the legal practices associated with emergency facilities. That bill is Texas HB 2041.
The author of the bill was Senator Kelly Hancock and Texas Governor Greg Abbott signed the bill into law back in July. Now that it has been enacted, HB 2041 eliminates the confusion between patients, health plans, and out-of-network health care providers if and when patients have little to no options for care—as is the case in emergencies. This legislation requires state-regulated health plans to reimburse out-of-network emergency or facility-based providers at either a “usual and customary rate or an agreed rate,” and providers are now allowed to settle disputes through arbitration.
Texas’ reputation for having one of the nation’s highest rates of surprise billing should hopefully change quite dramatically under the new HB 2041 bill. The law requires facilities to disclose their prices, particularly those facility fees we mentioned earlier, upon service to patients or by listing them on their website.
Additionally, Free Standing Emergency Rooms will also be barred from advertising they “take” or “accept” certain health plans if the facility is not in their network. Patients widely misunderstand what in-network might mean and displaying logos of certain health care provider plans contributes to that confusion.
Lack of transparency has led to significant emotional response from Texans, who after being polled showed that 97% believe patients should be told upfront what their medical procedures will cost. Under HB 2041, transparency will be emphasized, and patients will have a greater understanding of what they’re being charged if emergency care is required. In some cases, patients were being charged 10 times what they would pay if they chose in-network care. The bill hopes to alleviate some of this cost to patients.
What Texas HB2041 Means for You
Texas healthcare is no longer a guessing game. With the passing of HB 2041, Texans now have the transparency they’ve been asking for. The quality of health care won’t be affected, however. If anything, proponents of the bill say that it will make healthcare safer, more accessible, and won’t bankrupt Texans the way it has in the past. Surprise billing will no longer affect individuals who use the ER. The next time you use a freestanding emergency room you’ll have a complete understanding of the cost of your services and won’t be fooled into thinking that the services are in-network if they aren’t.
While in theory, freestanding urgent care rooms seemed like a good idea, regulation is required to keep them in check and from taking advantage of vulnerable segments of the population, including the senior citizen community.
To learn more about HB 2041 and how it will affect you, please give us a call. As health insurance brokers serving the Houston, Texas area, we are proud to provide you with the best information regarding health care in the State.
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