April 8, 2015 —

The Texas Association of Health Plans Weighs In With Support

AUSTIN—The Texas Association of Health Plans (TAHP) today weighed in with their support for Senate Bill 425, designed to protect Texas consumers from the often unknown expenses associated with seeking care at freestanding emergency rooms. Filed by Sen. Charles Schwertner, R-Georgetown, the bill requires emergency care facilities to be forthcoming regarding the fees and other charges patients might incur at freestanding emergency rooms. SB 425 was reported favorably out of the Senate Business and Commerce Committee yesterday.

“The health care system can be confusing and costly when consumers lack access to critical information. This is often the case when Texans visit freestanding emergency rooms. While freestanding ERs may be the right choice for many medical conditions, consumers who select these facilities for less-urgent or even routine care can be surprised when their medical bill arrives and they’ve been charged the same amount they would have paid to visit a traditional ER,” said Jamie Dudensing, CEO of TAHP and a former practicing nurse. “SB 425 would alleviate this problem by requiring facilities to provide more transparent information on capabilities, fees and network status. Given the already high cost of health care, Texans deserve easy access to information that will allow them to make the best choice for themselves and their families.”

Background: What Are Free-Standing ERs?

Since they were authorized by Texas Legislature in 2009, free-standing 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. Free-standing 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.

Free-standing 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 free-standing ERs appear and act much like urgent care centers, what many consumers do not know is that free-standing 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 free-standing 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.

Solution: SB 425

Senate Bill 425, sponsored by Senator Charles Schwertner, Chairman of the Senate Committee on Health and Human Services, would alleviate this problem by requiring free-standing ERs to provide more transparency about fees, prices and network status.

Senate Bill 425:

Requires freestanding ERs to post a prominent notice 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.