When you’re rushing to the emergency room, it’s likely that the furthest thing from your mind is whether your emergency room doctor is in your insurance network. And even if you do have the clarity of mind to check, you may still be faced with a surprise medical bill.

The Kaiser Family Foundation found that a third of all insured people still receive unexpected bills for health care. A “surprise medical bill” is a term used for charges that arise when “an insured individual inadvertently receives care from an out-of-network provider.”

“It looks like Texas is one of the worst when it comes to surprise medical bills,” says Stacey Pogue, a senior policy analyst at the Center for Public Policy Priorities (CPPP), a left-leaning think-tank based in Austin.

Even if you do seek treatment at an in-network hospital, there’s no guarantee that the doctor who sees you will also be in your insurance company’s network. Pogue says that around 300 hospitals in the state do not have a single in-network emergency room physician for one or more insurers that cover the hospital.

In 2009, the Texas Legislature developed a mediation system for Texans faced with surprise bills. CPPP found that less than 4,000 people have been able to initiate mediation through this process.

What you’ll hear in this segment:

  • Why so few people have been able to take advantage of the mediation system
  • What steps the Texas Legislature is taking this session to address surprise bills
  • Why a congressional solution is needed

Written by Molly Smith

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