SB 1264 and surprise medical bills in Texas

by Keely S.

You've heard the story before. Someone goes to an out-of-network hospital in the middle of an emergency, or they go to the right hospital only to find out later that one of the doctors was out of network. The results are the same: the patient can find themselves with scarily expensive bills.

Texas is one of a dozen states combatting surprise medical bills, which puts such a great burden on consumers. As big believers in patient advocacy and cost transparency, Take Command Health is excited to see this move toward progress in our home state.

While the recent legislation in Texas is a step in the right direction, it doesn’t go far enough to protect everyone. It falls about 9 million people short.

What is SB 1264?

SB 1264 was signed in June and will become effective January 1st, 2020. Under this new law, a patient never receives a surprise bill, and it's up to the provider and insurer to work out the differences. Essentially, it leaves the patient out of the frustrating and complicated process. This is a really good thing!

While it is great for those who have insurance regulated by the Texas State Department of Insurance, like teachers, state employees, small companies, and anyone who shops for their own plan on the individual market, it does not protect those on employer-sponsored plans from surprise medical bills. In other words, 14 million folks will reap the benefits but 9 million will be left behind (for now - we hope this changes in the future!).

Why it matters

Texans deserve better when it comes to surprise bills. Here are a few stats we found.

  • Texas has some of the nation's highest rates of out-of-network charges associated with hospital stays and emergency visits that could lead to surprise bills, according to a 2017 Kaiser Family Foundation analysis of claims from large employer insurance plans.
  • More than a quarter of hospital stays in Texas led to an out-of-network charge, tying the state with Kansas for the third-highest rate nationally.
  • Thirty-eight percent of emergency visits in Texas led to an out-of-network charge, the highest rate among all states.
  • The number of requests to the Texas Department of Insurance for help with surprise medical bills has grown each year since it started offering the service in 2009, totaling 9,843 through fiscal 2018.
  • With a month left in fiscal 2019, the Texas Department of Insurance has received 7,701 more requests for help with surprise medical bills.”

How to avoid surprise medical billing

Sometimes, those surprise medical bills are beyond our control. Two big offenders are ambulance rides and out-of-network anesthesiologists. To protect yourself, try to do the following leading up to a medical event.

  1. Understand what your plan covers. Research your preventive care coverage and billing codes before your visit.
  2. Check with your insurance company and doctors and hospital to make sure that you’ll be covered and not considered out-of-network. It isn’t always feasible to have all of this information up front, but try!
  3. Ask your doctor to use in-network labs for bloodwork, MRIs and other tests.
  4. After your treatment, ask for an itemized bill and look for procedures that you didn’t actually receive. Since these bills are often tough to decipher, call the hospital.
  5. If this all sounds confusing, enlist a patient advocate like the service we offer for our Smart Benefits members! They will do all of the above for you, as well as schedule doctor appointments, resolve medical billing issues, coordinate care and medical records, and understand your health plan’s benefits.

What to do if you get a surprise medical bill

Don’t panic. Our Smart Membership comes with bill negotiation from Compass. Read this mom’s story of how she saved $500 with our medical bill negotiation service!

Compass uses a proprietary technology platform to analyze bills for errors along with a team of expert medical billing advocates who negotiate on the consumers’ behalf. Apparently a whopping 80% of the bills have errors! 

Normally medical bill negotiation services take a 30% cut of the savings, but through the Take Command Health membership plan, this service is available to members for free!

Stay informed

There were efforts to pass another bill that would allow nonstate-regulated insurance plans to opt into the TDI mediation services, but they failed in the House after passing in the Senate. There are plans to continue to push this legislation forward next session. We’ll keep our fingers crossed that this comes to fruition. In the meantime, do your homework when it comes to your medical costs and call in help from medical bill negotiation when you need it!

We’re here to help you stay informed in this crazy political climate. Take Command Health can help save you money with HRA administration for ICHRA or QSEHRA, shop for individual health care plans, or connect you with our smart benefits program to enjoy all the extras that will make your life easier.


Picture of Keely S.

Hi, I'm Keely S.! A wife to one and mother to four, Keely does all of the things. She’s also dabbled in personal finance blogging and social media management, contributed to MetroFamily magazine, and is passionate about good food, treasure hunting and upcycling. With a B.S. in Psychology from the University of Oklahoma and a knack for a witty punchline, it’s no surprise that Keely’s social posts are as clever as they get. In her (very little) free time, you’ll find Keely with her nose in a book or trying out a local restaurant with her family.