New state guidelines could help clarify emergency medical billing

New state guidelines could help clarify emergency medical billing
(Source: KFDA)
(Source: KFDA)

AMARILLO, TX (KFDA) - The Texas legislative session begins Jan. 10, and there are plans to address issues concerning emergency patient's treatment.

Local physicians believe the legislature can help patient hardships by providing guidelines so patients and providers can be clear as to what their compensation is.

"Hopefully the legislature will come up with a guideline to better state what the reimbursement to the providers is going to be so there's no surprises especially to the patient," said Medical Director for Neighbors EC, Dr. Donald Hubbard. "Another issue that patients see is called surprise billing, hopefully there will be guidelines on what the reimbursement is going to be to patients."

Surprise billing can affect a patient if an insurance company decides to provide little reimbursement for an emergency visit.

Some providers will take that outstanding balance and refer it back to the patients, and many times this can be thousands of dollars.

This can be especially frustrating when a patient doesn't realize they are visiting an emergency room when they intended to visit an urgent care center.

"Some patients don't actually understand that they are coming to an emergency center, there's a lot of costs that goes into providing these services," Hubbard said. "We want to make these services are available, so patients can come and seek medical care in a place that's caring."

It may be hard for an emergency facility to know how much the insurance is going to pay until after a patient's visit.

But most times insurers will place the copay amount on the insurance cards.

It is also important to know which facilities will be covered by medicare or medicaid.

ER's affiliated with hospitals and most urgent cares will take this coverage but standalone ER's will bill, as they are prohibited to take this coverage at this time.

Copyright 2017 KFDA. All rights reserved.