March 13, 2017 —
AUSTIN—The Texas Association of Health Plans (TAHP), the statewide trade association representing commercial and public health plans operating in Texas, today applauded the introduction of four bills in the Texas Legislature to significantly increase transparency requirements of facilities known as freestanding emergency rooms. Texas is home to more than half the nation’s population of freestanding ERs, which largely choose to remain out of insurance networks, charge up to 10 times what urgent care centers charge for the same services and up to two times more than hospital-based ERs, and often use intentionally confusing advertising to mislead consumers into believing they are in their health plan networks.
The proposed legislation, SB 2240 by Sen. Larry Taylor; HB 3099 by Rep. Dennis Paul; HB 3276 by Rep. Tom Oliverson; and HB 3122 by Rep. Jessica Farrar, would require freestanding ERs to provide clear and easily understood information to consumers upfront about their network status and the fees they will charge consumers for their services.
“With health care costs rising across the board, more than ever consumers deserve greater transparency and more information to make the best health care decisions for their medical needs and their budgets. Freestanding ERs pose the biggest concerns for confusing advertising, scant details, out-of-network care, and exorbitant pricing. We applaud Sen. Taylor, Rep. Paul, Rep. Oliverson, and Rep. Farrar for seeking solutions to hold freestanding ERs accountable and better equip consumers so they can make more informed decisions and protect themselves against surprise medical bills,” said Jamie Dudensing, TAHP CEO and a former practicing nurse.
Specifically, the four legislative proposals would require freestanding ERs to notify consumers if their facilities and the physicians practicing at their facilities are in or out of network and for which health plans; provide to consumers in advance the minimum and maximum charges they could be charged for their visit; specify whether or not Medicare/Medicaid/Tricare are in-network for their facilities; and provide consumers with the name of the nearest urgent care center along with its address, hours and phone number, among other requirements.
Background on Freestanding ERs & Resources:
- There are more than 200 FSERs in Texas – more than half the nation’s population of these facilities.
- Freestanding ERs pose the highest risk or surprise medical bills for Texans and are responsible for nearly 70 percent of out-of-network emergency facility claims in Texas.
- Charge for treating a cough at a freestanding ER: $3,044. Treating a cough at an urgent care center: $180.
Read more about freestanding ERs and how they use misleading advertising, charge exorbitant prices, and refuse to go in network:
- Fact vs Fiction on Freestanding ERs
- Buyer Beware: Telling the Truth About Freestanding ERs
- Reining in Freestanding ERs
- Dallas Morning News Editorial: Billing abuses at standalone emergency care centers are costing Texans a hefty chunk of change
The Texas Association of Health Plans
The Texas Association of Health Plans (TAHP) is the statewide trade association representing private health insurers, health maintenance organizations, and other related health care entities operating in Texas. Our members provide health and supplemental benefits to Texans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. TAHP advocates for public and private health care solutions that improve the affordability, access and accountability of health care for many Texans. As the voice for health plans in Texas, TAHP strives to increase public awareness about our members’ services, health care delivery benefits and contributions to communities across Texas.