At Hearing, Advocates Warn of Steep, Unexpected Medical Bills

Even Texans who have health insurance often face steep, unexpected costs for emergency-room care, consumer advocates told a panel of state lawmakers Monday.

Senators on the State Affairs Committee met to address a charge from Lt. Gov. David Dewhurst, a Republican, to study "increasing medical price transparency" in advance of the legislative session that begins in January. Policy experts representing patients and hospitals expressed concern about the practice of “balance billing” — when consumers are asked to pay more for out-of-network care not paid for by an insurer.

Trey Berndt, an associate state director for advocacy with AARP, told lawmakers emergency-room visits present special challenges for price transparency because hospitals sometimes contract with emergency-room doctors who do not participate in the same insurance plans as the hospital. A website listing which hospitals have in-network doctors in their emergency rooms is not going to help a patient undergoing a stroke, he said.

“The transparency stuff does not work in an emergency situation. You don't have time," said Berndt, whose organization advocates for people of retirement age.

Citing a report released Monday by the left-leaning Center for Public Policy Priorities, Berndt said it was “alarming” that some hospitals have no in-network emergency doctors. 

The report found that in emergency rooms at roughly half of in-network hospitals for United Healthcare and Humana, two of the state’s three largest insurers, there were no in-network physicians.

Lawmakers also considered the transparency issue outside of emergency rooms. State Sen. Leticia Van de Putte, D-San Antonio, called on insurers to regularly update their lists of in-network doctors. She cited an example of a dead doctor who was still listed on one insurer's network. She also said the state's current transparency requirements — including a rule that insurers give written notice to patients who could face higher costs from out-of-network providers — are insufficient.

“It’s not working. It really isn’t working, at least from a patient base,” Van de Putte said.

Jamie Dudensing, chief executive of the Texas Association of Health Plans and Dewhurst’s former policy director, said most private insurers provide online cost estimators for medical procedures but that many patients nonetheless remain uninformed.

“Just because you have all this information out there available to consumers doesn’t mean they’ll actually use it,” she said.

Health care providers and insurers highlighted that problem throughout their testimony: More transparency does not necessarily result in more informed consumers, but it can create burdensome requirements for health care officials.

Charles Bailey, representing the Texas Hospital Association, said consumers were often overwhelmed by how complicated the health care system can be, but that “hospitals are doing their best to help educate” them. He acknowledged it was a problem that hospitals are “not always able” to employ in-network physicians.

Still, reform efforts lack a silver bullet, Bailey said.

“It’s not a simple answer,” he said. “There’s been a lot of proposals over the years, but unfortunately, as an industry, there hasn’t been a consensus on how to solve that problem,” because doing so would advance insurers’ powers at the expense of health care providers', or vice versa.

Representatives from the Texas Department of Insurance also testified Monday about their efforts to build a website to inform prospective buyers of health insurance, a requirement of a 2007 law to improve cost transparency.

Katrina Daniel, an associate commissioner of the department, said the state had received a $4 million federal grant for the website and was partnering with the University of Texas at Austin’s School of Public Health to improve it. 

But Sen. Craig Estes, Republican of Wichita Falls and chairman of the State Affairs Committee, cast doubt on how much the site would accomplish.

“People are not savvy consumers when it comes to their medical area,” he said. “You could have the greatest website in the world and people aren’t using it or don’t know about it.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

Disclosure: The University of Texas at Austin, AARP, the Texas Hospital Association and the Texas Association of Health Plans are corporate sponsors of The Texas Tribune. United Healthcare was a corporate sponsor in 2012. A complete list of Texas Tribune donors and sponsors can be viewed here.