Texas Sharpens Aim At Surprise Medical Bills In Bipartisan Proposal
The proposed legislation aims to reduce patients’ costs by beefing up a Texas Department of Insurance program that scrutinizes surprise balance bills greater than $500 from any emergency health care provider.
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A bipartisan group of Texas lawmakers announced plans this week to address surprise medical bills in a way they believe would ease the burden on patients in the state.
During a news conference Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, announced he had filed a bill in the Texas Legislature aimed at preventing medical providers from, among other things, balance billing patients — charging patients the difference between what the health care provider and the medical insurer think a medical service or procedure is worth. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is filing a similar bill in the House.
If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of SB 1264 is to take “the burden off of patients.”
“[It] takes it off of their plates completely,” Hancock said.
He highlighted the case of Drew Calver, a public school teacher in Austin whose six-figure hospital bill after a heart attack was featured in a “Bill of the Month” investigation last summer by NPR, Kaiser Health News and KUT, NPR’s member station in Austin. Hancock noted Calver’s bill was reduced after the media attention but said it shouldn’t take such attention for a patient to get a reasonable bill.
Under this legislation, both sides of the payment dispute would settle their issues through an existing balance bill mediation program. The Texas Department of Insurance program has been successful in lowering medical bills across the state.
The legislation would beef up the program, which addresses surprise balance bills greater than $500 from all emergency providers — including free-standing emergency departments and all out-of-network providers working at a network facility.
“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock said.
Historically, the Insurance Department’s mediation program had many loopholes, and few consumers qualified for help. It was expanded in 2017, though, and more patients have been filing complaints.
For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.
Hancock said the program, so far, has saved Texas patients $30 million.
Still, consumer advocates argue, the system works only when patients know mediation is an option.
Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, said patients don’t always know help is available, or they find the process intimidating.
“The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she told KUT earlier this year.
She and others have argued Texas should adopt a program similar to those in other states like New York, California and Florida, whose systems are more consumer-friendly.
Martinez Fischer said it’s time Texas officials stepped in to help patients who are caught in the middle of disputes between medical providers and health insurers. “It has been an industry issue for a few years, I grant you that — the health plans and the providers fighting over their business interests,” he said. “And I respect that. But 10 years later, it is a consumer issue.”
Among other things, Hancock’s bill would allow people with federally regulated, self-funded health plans to opt into the state’s mediation program. According to Hancock, those plans make up about 40 percent of Texas’ insurance market, but those consumers are currently not able to take part in the program.
Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.
“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock said. “Until then, Texas … [is] committed to doing something about it.”
U.S. Rep. Lloyd Doggett, a Democrat who represents Austin in Congress, said he is encouraged by Texas’ efforts but called federal protections “essential.”
“Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” Doggett said in a written statement.
This story is part of NPR’s reporting partnership with KUT and Kaiser Health News, an editorially independent news service of the Kaiser Family Foundation. You can follow Ashley Lopez on Twitter: @AshLopezRadio
Texas Sharpens Aim At Surprise Medical Bills In Bipartisan Proposal
The proposed legislation aims to reduce patients’ costs by beefing up a Texas Department of Insurance program that scrutinizes surprise balance bills greater than $500 from any emergency health care provider.
Kameleon007/Getty Images
hide caption
toggle caption
Kameleon007/Getty Images
A bipartisan group of Texas lawmakers announced plans this week to address surprise medical bills in a way they believe would ease the burden on patients in the state.
During a news conference Thursday, state Sen. Kelly Hancock, a Republican from suburban Fort Worth, announced he had filed a bill in the Texas Legislature aimed at preventing medical providers from, among other things, balance billing patients — charging patients the difference between what the health care provider and the medical insurer think a medical service or procedure is worth. State Rep. Trey Martinez Fischer, a Democrat from San Antonio, is filing a similar bill in the House.
If passed, the legislation would force medical providers and health insurers to mediate payment disputes before they send bills to patients. Hancock said the point of SB 1264 is to take “the burden off of patients.”
“[It] takes it off of their plates completely,” Hancock said.
He highlighted the case of Drew Calver, a public school teacher in Austin whose six-figure hospital bill after a heart attack was featured in a “Bill of the Month” investigation last summer by NPR, Kaiser Health News and KUT, NPR’s member station in Austin. Hancock noted Calver’s bill was reduced after the media attention but said it shouldn’t take such attention for a patient to get a reasonable bill.
Under this legislation, both sides of the payment dispute would settle their issues through an existing balance bill mediation program. The Texas Department of Insurance program has been successful in lowering medical bills across the state.
The legislation would beef up the program, which addresses surprise balance bills greater than $500 from all emergency providers — including free-standing emergency departments and all out-of-network providers working at a network facility.
“This is designed to apply in situations where patients don’t have any choice which facility they go to or which physician is involved in their care,” Hancock said.
Historically, the Insurance Department’s mediation program had many loopholes, and few consumers qualified for help. It was expanded in 2017, though, and more patients have been filing complaints.
For example, in 2014, the department was asked to mediate 686 medical bills. During the 2018 fiscal year, it received 4,445 bills.
Hancock said the program, so far, has saved Texas patients $30 million.
Still, consumer advocates argue, the system works only when patients know mediation is an option.
Stacey Pogue, a senior policy analyst with the Center for Public Policy Priorities, said patients don’t always know help is available, or they find the process intimidating.
“The instructions for how to do it are on your medical bill and your explanation of benefits — the most indecipherable documents you are going to get,” she told KUT earlier this year.
She and others have argued Texas should adopt a program similar to those in other states like New York, California and Florida, whose systems are more consumer-friendly.
Martinez Fischer said it’s time Texas officials stepped in to help patients who are caught in the middle of disputes between medical providers and health insurers. “It has been an industry issue for a few years, I grant you that — the health plans and the providers fighting over their business interests,” he said. “And I respect that. But 10 years later, it is a consumer issue.”
Among other things, Hancock’s bill would allow people with federally regulated, self-funded health plans to opt into the state’s mediation program. According to Hancock, those plans make up about 40 percent of Texas’ insurance market, but those consumers are currently not able to take part in the program.
Hancock said this should provide relief to consumers while federal lawmakers weigh their own efforts to address surprise medical bills.
“Texas will send a loud and clear signal to D.C. that similar consumer protections need to be passed at the federal level,” Hancock said. “Until then, Texas … [is] committed to doing something about it.”
U.S. Rep. Lloyd Doggett, a Democrat who represents Austin in Congress, said he is encouraged by Texas’ efforts but called federal protections “essential.”
“Only approval in Congress of legislation like my End Surprise Billing Act can both protect those who work for large employers with self-funded, federally regulated ERISA plans and assure that patients across America are not forced to pay the price for conflicts between insurers and health care providers,” Doggett said in a written statement.
This story is part of NPR’s reporting partnership with KUT and Kaiser Health News, an editorially independent news service of the Kaiser Family Foundation. You can follow Ashley Lopez on Twitter: @AshLopezRadio
Blair Braverman And Her 'Ugly Dogs' Prepare For Her First Iditarod
Rookie musher Blair Braverman and her dogs will compete in the Iditarod Trail Sled Dog Race, traveling more than 900 miles across Alaska from Anchorage to Nome and facing subzero temperatures and challenging trails.
Courtesy of Blair Braverman
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Courtesy of Blair Braverman
You know LeBron, Serena and Messi.
But do you know Pepe, Flame and Jenga?
They’re another kind of superathlete on a one-name basis with fans — sled dogs preparing for the Iditarod race.
Blair Braverman, the team’s musher, will take the dogs out for their first Iditarod when the race starts Saturday, braving some 938 miles of trail across Alaska, from Anchorage to Nome.
It’s a grueling race that took the last winner 9 1/2 days to complete, with unpredictable conditions, mandatory rest breaks and the notorious Happy River Steps, three near-vertical drops early in the course — just one of the many possible pitfalls for mushers trying not to crash.
1. Pepé
We have many dogs who can lead the team, but our true Lead Dog — the pup who makes each run happen, who gets us through every storm — is Pepe. Pepe is smarter than all of us. She will run forever and keep running. She is basically everyone’s mother. pic.twitter.com/K6ckFTvv6l
— Blair Braverman (@BlairBraverman) January 2, 2019
But this rookie is ready. Braverman has shipped food out ahead of time on bush planes, studied the weather, repaired equipment and made and remade plans.
“How can you not overthink a 900-mile race?” she tells NPR’s Ari Shapiro. “There’s just so many different things that have to fall into place. It’s like chess in the snow.”
Braverman, a dog-sledder, author and correspondent for Outside magazine, is one of 17 women racing in this year’s Iditarod, a record 32.7 percent of the field.
“Mushing is one of the only sports where men and women compete together at elite level,” she says. “We are taken seriously as athletes because there’s no chance for people to tell themselves we’re not on the same playing field.”
But she doesn’t consider herself just an athlete. She’s also a coach, a nutritionist, a parent, even a veterinary tech for her team. All her dogs, 14 hand-picked racers from a group of 20 that she has been training, have undergone physicals as extensive as the preparations for any professional athlete in the NBA or NFL, from electrocardiograms to vaccinations.
“They were gone over with a fine-tooth comb by this great volunteer team of vets,” Braverman says. “And I’m happy to report that they all have top marks in all their health records, and they’re doing great.”
The dogs are a sharp but motley crew of strong personalities. Pepe is the steady, “mature” head of the pack. Flame is Braverman’s “shadow” and has raced with her in every qualifier. Jenga, Flame’s half sister, “doesn’t suffer fools.”
2. Flame (age 5)
Flame is my souldog. She is desperately codependent and we are both happiest when we are in physical contact at all times. She is also, to my occasional surprise, a fantastic sled dog. She finished every one of my qualifiers with me and never seems to tire. pic.twitter.com/JpWVcWxb94
— Blair Braverman (@BlairBraverman) January 2, 2019
And there are others, like Boudica, who loves gentle kisses; Colbert, a “big hunk” who is afraid of heights; and Grinch, who didn’t make the Iditarod team because he had some directional trouble. On a recent outing, he stopped in his tracks and refused to run after Braverman turned the sled around to head north instead of south.
“He has the biggest heart,” she says. “The most energy. And he’s incredibly stupid.”
It’s clear from the way she talks about them that Braverman loves her dogs. And that love affair led her to start writing and tweeting. She describes the racers like you’d write about old friends, sharing their quirks, thrills and setbacks with tens of thousands of followers. She calls her followers #UglyDogs, co-opting a phrase lobbed at her online.
“A Twitter troll actually told me, ‘Go back to your ugly dogs, Karen.’ ” (Her name isn’t Karen.) “But I thought it was a beautiful sentence. … Then some fans of the team said, ‘We should be the ugly dogs because you’ll always come back to us.’ So it took off.”
Braverman suspects her account has gained traction because dog-sledding is a rural sport that takes place mostly out of sight — and her dogs give fans a way in. She spares no detail, from how to put booties on a dog that doesn’t like her feet touched to her crew’s bowel movements.
Pleased to report that everyone’s poops have been extra great lately. pic.twitter.com/qE0rMDqCER
— Blair Braverman (@BlairBraverman) February 26, 2019
“People are getting to know these dogs as pets, as friends, and they’re also seeing them as elite athletes,” she says. “It’s like rooting for your favorite sports team, but they all happen to be dogs.”
One of the biggest misconceptions that she’s trying to disperse? That the dogs are disposable. These are animals she has been with for years, she says, and she knows each of them as individuals.
Jenga’s favorite head rest is her daughter, Hunter. pic.twitter.com/3c8E5SZdS4
— Blair Braverman (@BlairBraverman) January 4, 2019
“I think rather than telling people how much we love these dogs,” she says, “they can just feel how much we love these dogs and how much we’re with them every step of the way.”
Braverman’s long days of preparation are winding down quickly. The Iditarod kicks in the Alaskan midmorning on Saturday, and she admits it’s terrifying to think about the race ahead.
But, she adds, “if I think about being out there with my dogs, who are my best friends and my family, I just get so much strength from that.” The long days, the sleep deprivation, the subzero temperatures — she’s tackling all of that with Pepe, Flame and the rest of her dogs. And that’s all the courage she needs.
The broadcast version of this story was produced by Dave Blanchard and edited by Matt Ozug.
