While some surprises might be seen as enjoyable, it’s safe to say no one wants to be hit with a surprise medical bill. The issue gained traction in the Texas Legislature last session, and a new state law took effect last week aiming to erase the financial pain of Texans’ “sticker shock” after an emergency procedure or hospital stay.

Consumer advocates have hailed the Texas measure as providing some of the best protection in the country, adding that it could serve as a template for other states. However, it’s important to point out that while the new law is an important step in the right direction, it affects only about one-third of Texans with private health insurance, according to a recent story from The Texas Tribune.

In Texas, the issue was especially prevalent in emergency room visits. According to data from the Texas Association of Health Plans, 1 in 3 ER admissions led to a surprise bill, almost double the national average. The new state law bans so-called “balance billing” for emergency care, although in nonemergency situations, there is an exception allowing providers to balance-bill those intentionally choosing an out-of-network provider.

Senate Bill 1264 is meant to keep patients out of the line of fire in billing disputes between state-regulated health insurance plans and health care providers. The practice of “balance billing” occurs when a health insurer did not pay the full price charged by an out-of-network doctor for a medical procedure. In that instance, the physician could bill the patient for the rest, the balance, of the cost.

Several of the cases received statewide coverage, including the account of an Austin schoolteacher who received a bill for more than $100,000 after a heart attack, trip to the emergency room and hospital stay that was out-of-network. Such cases took place more often than originally imagined, with patients being surprised to learn they suddenly owed staggering amounts of money. It was incredibly easy for people to find themselves trapped in such circumstances.

As the Tribune pointed out, a patient receiving surgery at a hospital within their health insurance network could unknowingly receive care from an out-of-network anesthesiologist, who could send the patient a huge bill for the balance if the insurer declined to pay the anesthesiologist’s full rate.

The new law means insurers and health care providers are required to leave the patient out of billing disputes and instead negotiate prices for out-of-network care using an arbitration process, according to the Tribune. While this is a great step in the right direction, as written, the law only applies to Texans with state-regulated health plans.

That includes the majority of state employees and public school teachers, those who purchase insurance through the Affordable Care Act marketplace and some who receive health insurance through their private employer. According to the Tribune, a person’s health insurance card will bear a “TDI” or “DOI” imprint if the health plan is state-regulated.

The new measure is welcome news for those whom it affects, and it’s certainly a step in the right direction, but the ultimate goal for Texas should be measures that make surprise medical bills a thing of the past.

That will likely require more legislative work as well as a continued and concerted push for transparency from insurance providers and health care providers, with consumers the ultimate beneficiary.

— Amarillo Globe-News