Houston Chronicle. Dec. 17, 2020.
Editorial: An ambulance should bring help, not a shocking bill
People don’t call for an ambulance because they want to. They call because they are facing a life-and-death medical emergency and don’t know where else to turn. Once help arrives, it should be the first step to recovery, not a ride to financial pain and worry down the road.
But that is what sometimes happens in Houston and across Texas because of a loophole in the state’s recently passed law to protect consumers from surprise medical bills.
An investigation by Houston Chronicle reporter Jenny Deam found that some people who make a 9-1-1 call for urgent medical assistance are being hit with four-figure ambulance charges they thought would be covered by their insurance. Depending on the policy, the consumer can be on the hook for some or all of the costs.
Most people have learned to navigate the “in-network,” “out-of-network” restrictions for routine medical needs. But that isn’t something most of us think about when calling for an ambulance, and it shouldn’t be.
Deam’s reporting found that all city-run ambulance services in Houston, the nation’s fourth-largest city, are out-of-network for all insurers, creating the likelihood of the very definition of a surprise medical billing.
The best hope for fixing the problem is to revisit the issue in the session of the Texas Legislature that begins Jan. 12. In the meantime, ambulance operators, insurance companies and other involved parties must do what they can to help consumers cut through the red tape and resolve billing disputes quickly.
Take the case of Michael Schwab, whose 1-year-old daughter suddenly went into convulsions at the family’s west Houston home. Deam reported that the seizure had ended by the time the ambulance arrived but in an abundance of caution, the girl was transported to Texas Children’s Hospital in Katy, six miles away, for a full exam.
When the ambulance bill arrived from the city, he was in for a shock: He owed $1,976.92. And because it was out-of-network his insurance plan didn’t cover any of it. As Schwab tried to navigate the system, he said the bill was turned over to a collection agency.
Things eventually worked out for Schwab as his daughter’s health scare was likely caused by a childhood viral infection with no complications. And Boon-Chapman, the company that administers his employer’s health plan, stepped in to negotiate the bill.
Nyle Leftwich, CEO of Boon-Chapman, said “99.8 percent of the time” the provider settles, usually agreeing to take some percentage of the federal Medicare rate for the treatment.
That’s how it should work, but too often doesn’t. The process can leave people arguing with the insurance company on one hand and the ambulance bill collectors on the other, while still coping with the emergency that prompted the 9-1-1 call in the first place.
The good news is that state Sen. Kelly Hancock, R-North Richland Hills, who has led the fight against surprise medical billings since 2009, says he and other lawmakers are ready to look at closing the ambulance-sized loophole when the Legislature convenes next month.
Hancock’s work on the 2019 Texas law sought to fix part of the problem by prohibiting doctors from sticking patients covered by state-regulated policies with bills that insurance companies refused to pay, requiring instead that the providers and insurers work out any differences over in- or out-of-network particulars themselves.
The legislation, however, didn’t cover ambulance bills because Hancock said there hadn’t been a lot of complaints about the issue filed with the Texas Department of Insurance and that ER costs and out-of-network billings had been the priority.
Gerard O’Brien, CEO and founder of ORION EMS, one of Houston’s largest private ambulance companies and president of the Texas Ambulance Association, told Deam that ambulance companies tend not to join insurance networks because they find in-network rates too low to be sustainable for their businesses.
He did say, however, that his industry is open to working with legislators to look at current pricing practices and try to come up with a solution that is “reasonable” for his members and the industry at large.
All sides need to come to the table during the session and work out a solution. Texans shouldn’t have to check their bank balance or flip through pages of their insurance policy before deciding whether they can afford to call for an ambulance.
___
San Antonio Express-News. Dec. 17, 2020.
Editorial: Bill the county $255,000 for use of arena? No, Spurs, no
The San Antonio Spurs have done a marvelous job building a winning brand. There are the five championships, obviously. Just as important, though, is the organization’s long track record of community service, and the genuine love Spurs players shower on our city.
When people talk about the so-called “Spurs way,” it’s a big compliment. The implication being winning begins with the foundation of character, discipline, service and a team-first approach. That’s why we were disappointed to read about the Spurs billing Bexar County $255,000 to use the AT&T Center as a voting site this past election.
Is this the Spurs way?
Unless there is a better explanation for these charges, the Spurs should withdraw this bill, and in the parlance of basketball talk, offer up Bexar County a “my bad.”
Why? Here are three considerations:
First and foremost, the AT&T Center is a county-owned building, which the Spurs lease. At the most basic level, it’s just backward that the Spurs organization, with a massive team payroll, is billing the county $255,000 because taxpayers used this taxpayer-owned building to vote safely during a pandemic.
Did the Spurs PR department not think about this framing? Certainly, the negative PR hit alone about this bill is worth $255,000.
Second, was the cost really $255,000? The Spurs say so, billing for security, parking lot staff and cleaning. While the Spurs have no obligation to subsidize voting - although there is a moral argument given the civic activism we have seen from athletes - this bill seems unusually high compared with other mega voting centers here and at arenas in other markets.
For example, as Express-News reporter Joshua Fechter recently outlined, the Alzafar Shrine and St. Paul’s Community Center mega voting sites cost the county $18,100 and $16,000, respectively.
It also is nowhere near the bills submitted in other NBA cities. The Houston Rockets billed $4,400. The Denver Nuggets billed $3,700. The Cleveland Cavaliers will be paid $300, which is the standard rate for any polling facility there. Six other teams didn’t bill anything - including the owners of the Utah Jazz, which refused a standard $50 stipend from the Salt Lake County Clerk’s office.
Third, let’s also remember that in October, Bexar County Commissioners Court agreed to allocate up to $2.2 million in CARES Act funding for “COVID-19 related modifications” at the AT&T Center - a move that benefits the Spurs.
___
Fort Worth Star-Telegram. Dec. 18, 2020.
Editorial: Don’t put all teachers next in COVID-19 vaccine line. Here’s how Texas should decide
Nearly everyone thinks their group is essential enough to be near the front of the line for the coronavirus vaccine.
Texas’ leaders and public health officials have the unenviable task of sorting through myriad requests. The state is prioritizing front-line hospital workers, those who’ve done heroic, dangerous work already treating COVID-19 patients. Also at the top of the list are EMTs and residents and staff at long-term care facilities. After that, for now, comes more health care workers, such as those at urgent-care facilities and pharmacists.
The debate about where to put teachers is heated, as all education matters have been during the pandemic. Fort Worth schools Superintendent Kent Scribner, who heads a group of leaders at large, urban districts, wants teachers included in the initial distribution group.
“Campus-based educators are on the front lines every day,” Scribner wrote to Gov. Greg Abbott. “While they are utilizing best practices in safety protocols, they are still at a much higher risk of contracting COVID than those of us who can work in a closed office setting or from home.”
He’s right that teachers are a priority. Getting schools fully open is critical to our recovery. Most importantly, there’s overwhelming evidence of psychological and social damage to kids, as well as huge lapses in learning. It’s an economic need to have schools running regularly, and the sign of normalcy will provide a psychic boost.
But Scribner’s group is overreaching. Distribution of the vaccine should seek to balance essentialness and vulnerability.
Putting every Texas teacher at the front of the line makes little sense. Other groups of workers are also keeping society afloat, and the right thing to do would be to inoculate the most vulnerable among each of those.
Why, for example, should a healthy 30-year-old teacher receive the vaccine before a 50-year-old cop or grocery clerk or bus driver with diabetes?
Some teacher groups have tried to portray schools as a particular hothouse of coronavirus transmission. But there’s little evidence of that. If proper protocols are followed, particularly masks and good ventilation, education is not a super-spreading activity.
Teachers in Texas are apparently of sturdier stock than their counterparts in places such as Los Angeles, where unions want schools closed through the spring. Texas districts do face, however, significant staffing issues. Many have had teachers out for weeks because they caught the virus or had to quarantine due to possible exposure. It’s been tough to find enough substitutes, too.
Vaccinating vulnerable teachers would ease those strains. It would promptly improve education, and that should be a priority after so many months of lost learning. But if the primary goal is to save lives, vulnerable workers in other essential groups are important, too.
And state health officials are hearing arguments from every corner of Texas about who should receive the vaccine next. The Dallas Morning News reported Wednesday that they’ve received appeals on behalf of ride-share and food-delivery companies, some employees of the agency that runs Texas’ electricity grid and audiologists, among others.
Some public-health experts contend that prisoners are a priority, given COVID-19 outbreaks in lockups and the close confinement that allows the virus to spread. Politically, that request is almost certain to fall on deaf ears.
Abbott and other leaders have declined so far to specify how vaccine distribution should proceed beyond the first phase. He suggested Thursday that teachers should be a priority.
Achieving normalcy, he told reporters in Austin, requires “teachers in a safe, secure situation, vaccinated, able to be in a classroom teaching without fear of getting COVID-19.”
The governor projected that more than 1 million Texans will probably be vaccinated by the end of the year. Abbott also expressed confidence that more doses will soon be available, noting that Moderna and other companies will release their versions in the coming months.
That’s all the more reason for the state to weigh both essential work and health vulnerability in doling out the first rounds of vaccine. Every decision should work toward saving lives and slowing the pandemic.
And that means some - but not all - teachers should be in line soon.
END
Please read our comment policy before commenting.