Health Law Highlights

Now in Effect: Texas Ends Surprise Bills for Ambulance Rides

From D Magazine, by Will Maddox:

Surprise medical billing has largely been eliminated due to federal and state legislative efforts, but ambulance billing was not included in these regulations. A new Texas law now prevents surprise bills for ambulance services for those with state health insurance plans.

Emergency physicians and anesthesiologists were the most common sources of surprise bills, with research indicating that one in four ambulance rides results in a surprise bill. Approximately 60% of ambulance providers, both private and public, are out of network.

Bipartisan State Bill 2476 prohibits out-of-network ambulance providers from sending patients surprise bills, requiring insurers to cover costs based on local rates set by counties and cities. If no local ambulance rate exists, insurers will pay the lesser of 325% of the Medicare reimbursement rate or the full billed charge.

The new bill simplifies the initial surprise bill process, which had led to numerous lawsuits filed by the Texas Medical Association challenging the process for settling a surprise bill as directed by the federal No Surprises Act.

The new rules only cover those on state healthcare plans, including state employees and teachers, approximately one in three Texans.