May 19, 2015 —

TAHP Weighs in with Support

AUSTIN—The Texas Association of Health Plans (TAHP) weighed in with their support for Senate Bill 425, which the Texas Senate today sent to the Governor for his signature. Senate Bill 425, sponsored by Senator Charles Schwertner, Chairman of the Senate Committee on Health and Human Services, is designed to protect Texas consumers from the often unknown expenses associated with seeking care at freestanding emergency rooms. The bill requires emergency care facilities to be forthcoming regarding the fees and other charges patients might incur at freestanding emergency rooms.

“While freestanding ERs may be the right choice for certain medical situations, many Texans are unaware that these facilities can charge four-to-five times more than their look-alike, urgent care centers. SB 425 would help Texas consumers make more informed decisions about where to seek care for various medical situations and know upfront that if they visit a freestanding ER, they will be charged the same amount they would pay to visit a traditional ER. It’s essential that Texas consumers have access to critical information to help them navigate what can be a costly and confusing system,” said Jamie Dudensing, CEO of TAHP and a former practicing nurse.

Background: What Are Free-Standing ERs?

Since they were authorized by Texas Legislature in 2009, freestanding emergency rooms have become a popular option for Texans across the state experiencing a medical situation that may, in their opinion, not merit a trip to a hospital ER. Freestanding ER’s—as their name would suggest—are not attached to hospitals, but offer many of the same services that traditional hospital ERs offer, including 24-hour service and board-certified emergency specialists.

Freestanding ER’s are often selected by patients because they can easily access one in a nearby shopping center, and many provide shorter wait times than traditional hospital ERs. While freestanding ERs appear and act much like urgent care centers, what many consumers do not know is that freestanding ER’s may charge up to four-to-five times more than urgent care centers for the same services. First-time customers are often surprised to learn that freestanding ERs typically levy facility fees, similar to a traditional ER, on top of charges for the treating physician, resulting in large and unexpected medical bills for Texas consumers.

Senate Bill 425:

Requires freestanding ERs to post a prominent notice—and also include this notice on their web site—that clearly includes the following information:

  • The facility is an emergency room
  • The facility charges rates comparable to a hospital emergency department, including a possible facility fee
  • The physician may bill separately from the facility
  • The facility and facility-based physicians may not be a participating provider in an individual’s health plan network.

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.