What is the state of Texas doing about surprise billing?

EMERGICON Blog Covers (2)

Surprise billing has been a hot topic for legislators in the state of Texas. If you missed our first 2 blogs about this situation, be sure to check out Why surprise billing is really a surprise and Who should pay for EMS services.

Effective January 1, 2022, air medical emergency response crews are not allowed to balance bill patients in the state of Texas. This means that the difference between the fee for the air medical transport and what the primary payer (Medicare or commercial insurance, for example) pay for the service cannot be passed on to the patient. This legislation reduces the amount of money an air EMS service can recuperate for providing its services, to the tune of hundreds of thousands of dollars per year.

This legislation does not currently apply to ground EMS, but there is a potential that it could. Advocates for EMS services in Texas, including TXEMSA, are working to education law makers on the potential impact this legislation could have on the operability of municipal EMS services. If ground ambulance services lose the ability to balance bill patients, knowing that commercial insurance companies don’t consider emergency medical service in-network and therefore reimburse at lower rates, ground ambulance services will face a significant reduction in funding.

No one wants to experience a medical emergency. No one wants to pay unexpected, expensive medical bills. But without the active participation of commercial insurers reimbursing EMS services at levels that can cover the cost of delivering care, there aren’t many options for EMS services who are committed to being there for their citizens.

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