How Oversight of Insurance Companies can prevent Surprise Medical Bills

How Oversight of Insurance Companies can prevent Surprise Medical Bills

Surprise medical bills are one of the biggest problems that both patients and the physicians agree on. It is frustrating when you get an unexpected medical bill that will cost you up to thousands of dollars, yet you have health insurance. The surprise medical bills are usually a product of the doings of insurance companies. It is part of the business strategy insurance companies providing health insurance use to make them look more valuable.

A patient will purchase a health insurance package with the hope that it will help them pay for their medical care. But for insurance companies, it is a business. So what they do is that they create a sufficiently and irresistibly attractive plan, enroll policyholders then work around to ensure that the biggest chunk of the cash they receive stays with them instead of going to health care for the patients. Additionally, they will advertise and recommend specific physicians and medical facilities just to save more money. The end result is that the insurance companies end up benefiting while the patients are left having to bear the costs of their medical bills.

To get the burden of such bills off the back of patients, Bellaire ER advocates for the idea of oversight of insurance companies. This will help regulate the policies and actions of health insurance service providers to the benefit the patients. Most of the states, including Texas, have laws that require insurers to cater for the costs of non-contracted emergency health care and at the normal rates. The problem comes when you look at the guidelines. The guidelines that govern this law are not uniform, providing room to the insurance companies to determine their own rates. That is why you will find a good number of insurance companies having a payments percentage that is way lower than what the law stipulates. The result is the burden of surprise medical bills being created as the patients end up not receiving the full benefits they ought to receive from their health insurance provider.

Freestanding emergency rooms have been a popular target for health insurance companies. The model of freestanding emergency rooms is quite an innovative one and provides better access to emergency care for patients more effectively and efficiently. But they have been accused of misleading patients and lacking transparency; as per the narrative that insurance companies have. They use this as their basis for processing freestanding emergency center claims. As per the law in Texas, FECs are recognized as essential and are supposed to be processed at the same level as in-network benefit or the normal customary level. However, insurance providers use their “lack of transparency” excuse and the lack of clear guidelines in the law to charge out-of-network rates for freestanding emergency center claims. They end up denying the patient’s coverage access yet they are paying their insurance rates. The result is higher patient responsibility in the form of the surprise bills.

In a move deemed as a step towards the right direction for Texas, the Texas Association of Freestanding Emergency Centers passed a resolution that calls for the Texas Department of Insurance and the Texas Legislative arm to increase and improve data collection with regards to health insurance payment. With this data, it will be much easier for both the patients and the insurance providers to be certain as to what constitutes the customary reimbursement for Texas emergency room procedures. This is part of the efforts that are being made to improve the oversight and the transparency of health insurance companies and the health insurance industry in general.

Data from the Texas Department of Insurance clearly shows that there has been systematic attempts by a good number of insurance companies to slash the payments slated for freestanding emergency centers and have the costs channeled to their patients instead. In fact, some of these insurance companies go as far as keeping the freestanding emergency centers in the out-of-network category intentionally just to ensure that they pay the least amount possible in healthcare claims. This is a chronic practice that can only be stopped with increased oversight of these health insurance service providers to ensure that they are fair to their customers.

This behavior is becoming increasingly rampant and more people are not realizing the benefits of having a health insurance cover. To turn the tables in favor of the patients and against the “greedy” profit approach that insurance companies are employing, the legislative arm of the Texas Government should make it a priority to establish the appropriate laws and clear guidelines to regulate health insurance companies. They should come up with clear standards that are easily enforceable for reimbursements rates that can hold health plans accountable. The main goal is ensuring that all citizens get easy, affordable and reliable access to quality health care. A clear oversight of insurance companies will go a long way in ensuring the realization of this goal.