Feb 13, 2019

Texas' overwhelmed plan to help with surprise medical bills

Texas has a way to help patients appeal their surprise medical bills. It's not open to everyone. But it's still overwhelmed and unable to keep up with demand.

How it works: Texas operates a mediation program for patients hit with a surprise out-of-network bill, and it has expanded access to the program twice over the past 4 years.

  • The Texas Tribune lays out the details: Once patients file their bill with the state board, any bill collections are paused and insurers and providers have 30 days to work something out.
  • Most cases are resolved there. The others are referred to a formal mediation process.

By the numbers: Demand for the program skyrocketed last year, per the Tribune.

  • Texas received just 43 mediation requests in 2013. Last year, it received more than 4,500 complaints, totaling almost $9 million in hospital charges. Officials are expecting more than 8,000 new requests this year.

That's more than the commission can keep up with, and it's been trying to grow while still managing a workload that's very time sensitive for patients.

  • "It's somewhat like trying to rebuild the firehouse while you're answering calls to put out fires," Texas insurance commissioner Kent Sullivan said.

Go deeper: Why ending surprise medical bills is harder than it looks

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