EDITORIAL: No surprises: Proposal seeks to aid patients by reducing unexpected costs

The Texas Capitol in Austin.

Rio Grande Valley residents don’t always have many choices in certain medical procedures, especially in local emergency rooms. And when they’re hurting, they might agree to anything a doctor recommends if it will make the pain go away. Weeks later, when the bills start to arrive, a new emergency, financial in nature, can arise, especially when some of those charges are unexpected.

A bill in the Texas Legislature aims to address those surprise charges. If it doesn’t impose unreasonable restrictions that cause insurers to drop coverage or raise premiums, it could help many local residents.

The Valley has made significant improvements in the availability and quality of health care in recent years. Fewer patients have to go to other areas for medical procedures that until recently weren’t offered here at all. Some of those procedures, however, are still performed only by a few medical professionals. In some cases only a few doctors are trained or certified to perform certain procedures, in others the latest diagnostic technology still hasn’t attained widespread use in the Valley.

That shortage affects the cost as well as access to medical care. Writing in New Yorker magazine in 2009, doctor and medical journalist Atul Gawande reported that while the quality of health care in the Valley generally was average and the number of medical specialists per capita and doctors in general was lower than the national average, this area was the second-most expensive healthcare market in the country, behind only the Miami, Fla., area.

In order to reduce costs and in turn premiums, insurance companies usually try to recruit doctors and medical centers that are willing to agree to price controls in return for the insurers’ support. A paucity of specialists raises the likelihood that no one in the area belongs to a patients’ insurance network. That can lead to bills, sometimes in the thousands, that the insurer doesn’t cover.

The Texas Association of Health Plans reports that 1 in 3 emergency room admissions in Texas leads to a surprise bill to the patient, almost twice the national average. The association endorses a bill by state Rep. Trey Martinez Fischer, D-San Antonio, and Sen. Kelly Hancock, R-North Richland Hills, that aims to reduce such surprise bills.

The bill would ban out-of-network providers from sending surprise bills when the patient had no choice; require health plans to pay reasonable or negotiated amounts for our-of-network emergency care, with mediation to resolve disputes; make patients responsible only for the co-pays and other costs relative to their insurance plans; and prevent health providers from filing negative credit reports because of a patient’s inability to pay.

We trust insurers and health professionals will recognize the value in helping people get the medical care they need, and will work with legislators to craft a law that won’t cause doctors to leave their networks or insurers to raise their premiums unfairly in response to the bill’s restrictions. After all, providing care that improves patients’ lives, at a cost they can actually pay, seems the most desirable goal.