Hospital patients stuck with a surprise doctor’s bill that’s not covered by their insurance will finally have a "seat at the table" in negotiating with doctors charging them for out-of-network services, said state Rep. Kelly Hancock, R-North Richland Hills.

A law Hancock sponsored addresses balance billing, a practice that he said has been the bane of many of his constituents. For instance, when a woman gives birth at a hospital covered by her insurance and an out-of-network neonatologist treats her child, the physician bills the mother for the difference between what the insurance pays and what the doctor charges.

"The power rests with the physicians and the power rests with the insurance companies," Hancock said. "The patients, our constituents, were the ones with no leverage. All of a sudden a bill shows up and they’re expected to pay it. So this brings them to the table and gives them a little more leverage that they didn’t have previously."

At least nine other states ban balance billing HMO members, according to a 2006 survey.

The concern is that patients, particularly in emergency situations, don’t control who treats them and that sometimes patients are overbilled but pay anyway because they can’t afford legal fees to dispute the charges.

Hancock said an outright ban would have bogged down the system.

"It didn’t really help their situation," Hancock said.

The law, which takes effect in September, allows enrollees covered by a preferred-provider benefit plan or state benefit plan to request mediation of out-of-network claims filed by an anesthesiologist, pathologist, radiologist, emergency physician or neonatologist.

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