Texas law on surprise medical bills will go into effect Jan. 1

AUSTIN (Nexstar) — Experts say starting in the new year, Texas will have one of the strongest laws protecting patients from surprise medical bills.

Earlier this month, consumer advocacy groups expressed concern over the Texas Medical Board’s proposed rule that they say would’ve created a loophole in the law. The rule would’ve allowed all out-of-network doctors to give their patients opt-out forms when it comes to non-emergency care. However, the board withdrew the proposals after backlash and criticism from groups, as well as Lt. Gov. Dan Patrick.

“The good news is that it all got fixed,” said Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities. “There’s no more loophole. There’s been a new rule issued and there’s not a loophole in that.”

Lawmakers worked on Senate Bill 1264 during the 86th Legislature. It protects patients with state-regulated health plans from getting surprise medical bills and leaves billing negotiations between insurance plans and providers. There’s also a narrow exception when a patient specifically chooses an out-of-network doctor knowingly.

The Texas Department of Insurance adopted emergency rules mid-December related to the law and experts say it mirrors the intent of the legislation closely.

“This emergency rulemaking reflects the intent of the Legislature and comes as a welcome relief for consumers nervous about losing their long-awaited protections,” said Blake Hutson, AARP Texas associate state director.

“There’s no patient that’s ever going to be backed into a corner and be asked to sign away their protections and pay more when they have no choice,” Pogue said.

However, this state law only applies to 16% of Texans, according to the Texas Department of Insurance.

“The good news is lawmakers in Austin have done everything they can to protect consumers,” Pogue said. “The bad news is, with the way the law works, they simply can’t write laws that are regulated at the federal level. We need Congress in Washington D.C. to act, to pass something that’s similar to what we’ve done here. We need to protect consumers from surprise medical bills.”