Increasing Number of Surprise Medical Bills for the Insured

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MCALLEN – Some Rio Grande Valley doctors are calling on the state to enforce rules and regulations that would keep patients from receiving surprise medical bills.

Dr. Victor Gonzalez said insured patients receive surprise bills when they receive services not provided by their plan or when they visit a doctor outside of their network.

He said many of the insurance companies in the Valley do not have specialists in the network who are associated with in-network hospitals.

For example, a patient could go to a hospital that’s in-network and get sent to a radiologist for x-rays, only to have to pay for the x-rays later because the radiologist was not in-network.

“Sometimes there’s a conflict because not all the hospitals or all the physicians are in the same network. And that’s something termed narrow network. And this is, unfortunately, becoming much more common,” Dr. Gonzalez said.

He said there are state rules and regulations meant to ensure insurance providers have adequate networks but the rules are not enforced.

Dr. Gonzalez is a member of the Texas Medical Association. He said the group is pushing for new legislation to fix the problem.

They want to require insurance companies to have mediation hearings for patients who receive bills over $500 and for companies to better inform patients of their plans.

The Texas Medical Association has some tips on how to avoid surprise bills.

  • Do not assume a doctor or clinic is in-network just because the office says they accept all insurance.
  • Educate yourself on your plan and set aside money each month if you have to meet a deductible.
  • Do not choose a plan just because the monthly premium is low.
  • You need to research what hospitals are in-network and if there are all specialists you may need in-network. 


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