AUSTIN, Texas — It can be a major setback for Texas health care consumers: a surprise bill for thousands of dollars from a doctor who isn't in your insurance company's network. Texas lawmakers approved a mediation plan in 2015 to allow patients to negotiate those bills, but health care advocates say it's so complex that too few consumers are using it.

According to Stacey Pogue, senior policy analyst with the Center for Public Policy Priorities, under the current payment system, a medical procedure can become a Catch-22 for the patient.

"Say, a colonoscopy - they often find out if their doctor is in-network and the facility is in-network,” Pogue said. "But they don't know to ask - or they can't get good information on - whether the anesthesiologist is going to be in-network; if they have a biopsy and it goes to a lab, if that pathologist in network."

Pogue said patients, particularly during emergencies, are rarely informed that they may be treated by an out-of-network provider, and those bills must be paid in addition to any deductibles or co-pays. She said Texas legislators are looking at several ways to address the problem, simplify the process and make it easier to arbitrate the bill.

Surprise bills have become a hot potato the health care system doesn't want to deal with, Pogue said.

"Insurance companies, as you can imagine, and doctors don't agree on who should pick up the tab. Today, they just push it off on patients because they can,” she said. "And so, if the Legislature says 'No, you can't push that cost off on a patient,' what these other agencies care about is who has to pick up that cost. And that's the complicating factor."

Since 2015, about 250,000 Texans who received out-of-network bills were eligible for mediation, Pogue said, but fewer than 4,000 have taken advantage of it.

"Hopefully, it'll also help consumers know about the program, because that's one of the biggest barriers is that they created this program to help consumers, but they don't know about it,” she said. "It does require that there's a notice that's put on your medical bill that you have a right to mediation."

Pogue said she's confident that the Legislature will act on surprise medical bills this session. She said the issue has bipartisan support in both the House and Senate.

A report, written by Pogue, on the issue of surprise out-of-network medical bills is available here.


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September is Self-Care Awareness Month and the American Heart Association in Missouri is urging caregivers to take some much-needed time for themselves.

Missouri has around 600,000 family caregivers, many of whom provide unpaid care to loved ones with heart disease, cardiac events and other debilitating illnesses. The emotional and physical toll can be severe, with 21% of caregivers reporting their own health has declined.

Dr. Ravi Johar, chief medical officer for UnitedHealthcare and a member of the American Heart Association of St. Louis, wants caregivers to understand proper self-care is not selfish.

"It's really important that after an acute event, whenever you've had a chance to kind of catch your breath, sit down and think about exactly what they need and exactly what you need and how much you can give," Johar recommended. "That's not being selfish. That's not, not taking care of them. That's doing the right thing for both of you."

According to the American Heart Association, it is important for caregivers to have someone they can confide in about their fears and doubts; a person who can offer reassurance and emotional support.

A 2023 AARP survey showed nearly 40% of family caregivers spend more than 20 hours a week assisting their loved ones from driving to appointments to providing direct care, many while also working and raising children. Johar stressed the importance of caregivers using time off from work wisely, which includes new mothers with babies in neonatal intensive care.

"The baby's getting the best care in the hospital and there's nothing you can do to help," Johar pointed out. "Go ahead and go back to work. Save that time, go in every evening. Spend all night or as much time as you want with the baby. But save your time off, because when this baby comes home, then you're really going to need to be there."

Doctors also emphasized the critical role of regular exercise, like brisk walks and the need for caregivers of all ages to maintain a heart-healthy diet. The habits help manage stress and boost energy levels.

Self-measuring blood pressure sites are coming to the Northwest, starting with a community organization in Portland.

The American Heart Association and Providence Health Plan have launched a program to bring self-monitoring blood pressure equipment to 20 clinics and community organizations in Oregon and Washington. The first was introduced at the Portland Opportunities and Industrialization Center, a training center serving more than 3,000 students age 17-65.

Michael Hale, a health navigator at the center, said some people get "white coat syndrome" when they visit the doctor, causing inaccurate blood pressure numbers.

"The beauty of this program is to be able to have our staff use the blood pressure monitors at home or in their office when they're regulated, before they drink their coffee," Hale explained. "Then they'll be able to log it throughout the week and then use that information, take it to the doctor."

Hale pointed out people can then discuss with their doctors whether it's time for blood pressure medication or lifestyle changes, depending on the readings. The program will loan out blood pressure monitoring equipment to students, families and staff at the center.

Blood pressure is an important indicator of health. Left untreated, high blood pressure can lead to heart attack, stroke and other health issues.

Meredith Collett, executive director of the American Heart Association of Oregon and southwest Washington, said the program is designed to bring monitoring to people who may not have access.

"Our hope with our collaboration with Providence Health Plan is to remove those barriers to health care access by setting up these self-measured blood pressure cuffs with POIC for at-risk communities," Collett noted. "They can really track and understand their numbers."

The initiative to bring self-measuring blood pressure equipment to clinics and organizations in the Northwest is expected to expand to 20 over the next three years.

Nonprofits across Texas are coming together to address disparities in health care for the Latinx community. A report by the Commonwealth Fund shows some factors that lead to the differences in health care include high poverty rates, elevated levels of pollution and crime and a lack of green spaces.

Paulina Sosa, Latinx Voces founder, said many in the Latinx community lack access to vital resources that could improve their overall health.

"Lack of physical access to a clinic or a doctor, the lack of information on how to go about accessing those health care services, and of course, it could be related to the lack of linguistics, otherwise known as information in Spanish," she said.

She added health disparities that had been in existence for years were brought to light during the COVID-19 pandemic when Hispanics experienced some of the highest death rates.

Edgar Carmona, president of the nonprofit Alliance for Progress in Dallas, which works to reduce health-care disparities among vulnerable populations, said some in the Latinx community don't seek medical care because they don't trust caregivers from other races.

"We just don't see the medical community being able to represent the community that it serves. We, as a society, are perhaps not creating the opportunities needed, or the encouragement for our youth to go into this field," he continued.

Both Sosa and Carmona said collaborations can help improve health outcomes for the Latinx community. Sosa added that during and after the pandemic, community partners, small businesses and faith-based organizations worked together to improve the lives of those most vulnerable.

"How do we ensure that the momentum, around addressing these disparities - particularly for Latino and Spanish-speaking communities - how do we ensure that the momentum continues? That is one of the biggest questions we're trying to tackle. We really believe that partnership is at the center of that solution," Sosa said.


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