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Mediating unexpected medical bills under new Texas law

Waking up in an emergency room and finding out that you've been in an accident can be a shock. Getting the medical bill for the care you have received can be just as shocking -- even if you have health insurance.

Medical bills have added insult to injury for many patients who were unknowingly treated by physicians who are outside of their insurance carriers' networks, sometimes at hospitals that were within their networks.

Undoubtedly, this is an extremely frustrating situation to be in, and Texas residents told state lawmakers their stories. In response, the legislature passed a law that makes it possible to challenge the bills through mediation.

Currently under Texas Insurance Code Chapter 1467, mediation is only an option for patients who have received a medical bill of at least $1,000. But in September, when the new law takes effect, mediation will open up to patients with bills of $500 or more.

After an individual has requested mediation, the doctor or hospital cannot attempt to collect payment for the bill, except for copayments, deductibles and coinsurance.

While requesting mediation doesn't mean that the patient will be off-the-hook for the bill, it is likely that the bill will be reduced to a manageable amount. The patient also retains the right to take the medical bill to court if an agreement is not reached.

The new law, which was signed by the governor earlier this month, is something that consumer advocates have been recommending for some time.

They know that all it takes is one medical emergency for a family's finances to be completely ruined. In many instances, families never recover from being hit with an expensive, unexpected medical bill, whether they have insurance coverage or not.

Around 43 million Americans have debt stemming from medical bills, according to a report released by the Consumer Financial Protection Bureau in December. Oftentimes, the debt is so great that people find it impossible to pay back. Then, when the debt goes unpaid, their credit scores are destroyed.

In some cases, mediation is a way to work with your insurance carrier and your physician to reach a fair settlement. In other cases, bankruptcy may be the only choice. Either way, meeting with a bankruptcy lawyer can help you understand your rights and options under the law.

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Gipson, Norman & Root
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