Michigan Association of Health Plans

Texas ruling on $11,000 ER bill may have long-lasting effects

Originally published by Denton Record-Chronicle 

The health care industry is closely watching a recent decision by the Texas Supreme Court that some say could have broader implications on how hospitals and health insurers negotiate their rates.

The court sided with an uninsured woman who was billed $11,037 after an emergency room visit.

The justices said that in order to prove her bill was “reasonable” compared with what an insured patient would be billed, the medical center would need to share in court details about the discounted rates it had with health insurers, data that’s generally seen as proprietary and confidential.

The case outlines the complexities of health care billing that consumers often see as arbitrary, confusing and not transparent, whether they have insurance or not.

While few dispute that costs are out of control and transparency would help, the ruling is seen as unprecedented by some, who worry it could deal a big blow to free market competition in health care.

The hospital had fought to prevent the data on its charges from being admissible at trial, saying it wasn’t relevant since the woman was not insured. But in a ruling published Friday, the Texas Supreme Court disagreed.

Read the full story at: https://www.dentonrc.com/news/state/experts-texas-ruling-on-er-bill-may-have-long-lasting/article_700c7a17-a320-547f-9964-44a25d53aaea.html