Preventing surprise medical bills could be derailed

This article was originally published by TDSR member Robert Luedecke, MD in the San Antonio Express News.

Surprise medical bills have long been a big problem in Texas. Gov. Greg Abbott announced this would be solved in 2019. A law, said to be one of the toughest in the nation, was passed. Now two authors of that bill say it could be completely undone in the rules phase.

At issue is how patients will be better served: by the ability to sign away protections of this law on the day of a procedure, or by signing any waiver several days before a nonemergency procedure.

Under one provision of the law, patients could be notified in advance of the procedure that some doctors are not “in network” with their insurance and bills may greatly exceed what their insurance will pay. The law’s authors say they included the provision to allow for patient choice.

Some doctor groups, including the Texas Medical Association, say that notification immediately before the procedure is adequate to prevent “surprise” bills. Consumer protection groups, including AARP and the Center for Public Policy Priorities, say the law was never intended to provide a choice between agreeing to pay more or not being treated. Some doctors may be inconvenienced by needing to verify well in advance that everyone caring for the patient will agree to accept the same pay as if they are in network, but placing responsibility solely on patients is the very problem the law intended to fix.

I am a member of TMA, and I might increase my income if patients can be notified before the procedure. But I cannot agree this would meet the intent of the law or would be fair to patients. I believe it is wrong to make more money by surprising patients. As an anesthesiologist, I see many patients who are stressed before a procedure. It is not appropriate to require them to decide to sign away their surprise billing protections on the day of the procedure.

Rep. Tom Oliverson, an anesthesiologist and one author of the bill, has said allowing waivers to be signed just before the procedure “will undo the law.” In an Express-News interview, Oliverson says he favors about a week’s notice for out-of-network charges before the procedure is done. He said, “It’s got to be crystal clear to the patient that they are giving up their protection,” and patients need time to think about their choices.

When I go to do anesthesia, the patient has already taken off from work and allowed time for recovery from a surgery. There would be intense pressure on patients to sign away protections so their procedures would not be delayed.

Oliverson and I agree a deadline of one week prior to the procedure would be reasonable for patients to decide whether they agree to pay more. This gives patients the option of proceeding or rescheduling with all in-network providers. On the day of surgery, the patient signs informed consent documents saying they understand the potential benefits and risks of the procedure, but this is clearly laid out in the surgeon’s office well ahead of the day of the procedure. Signing the surgical consent form is different from signing away your protections from surprise billing on the day of elective surgery.

Robert Luedecke, M.D., has been in the private practice of anesthesia in San Antonio for over 35 years.