Texas lawmakers push for more transparent medical billing: What it means for you

This report is an update to KXAN's "Medical Debt Lawsuits" investigation. Our team will continue to follow the bills during Texas' legislative session. 

AUSTIN (KXAN) — As soon as State Rep. Caroline Harris, R-Round Rock, was elected, she knew one of her top priorities would be healthcare. 

"If you look at how much money is spent in a family's budget, a large portion of it is on medical bills, or health care," she said. "And so my passion has always been — how can I kind of lift that burden for people and make it easier for them to understand their healthcare."

Harris felt she could do that by filing one of her first pieces of legislation — House Bill 1973.

"One of my favorite parts about the bill is not only does it have to show, you know, what the health care providers spend on your care, but it also has to be in terms that you can understand," she explained. 

The bill would apply to all healthcare providers — from doctors at a family practice to anyone treating patients at hospitals. 

What would you get?

"You would receive either electronically or on paper, a list of everything they spent on you. So, if they gave you a Kleenex, it will have the Kleenex listed and the cost next to it. And it'll have how much your insurance is going to cover. And it'll have it in terms that you can understand. And so, you can take that home, you can go through it, and you can make sure that you actually got the care that they're saying they provided to you," she said. 

The push for the bill comes after a KXAN investigation revealed hundreds of lawsuits piling up in a Central Texas court — filed on behalf of one local hospital in Williamson County which is part of Harris' district. 

Several patients told KXAN investigators they didn't pay their bills because they couldn't get an itemized invoice even though they asked for one. They said they wanted to understand exactly why they were being charged. For privacy reasons, the hospital wouldn't comment about specific patients. 

"The medical debt industry is now almost $200 billion worth of an industry. That is absolutely an incredible number. And so, to think that, you know, there are people in my area, that are caught up in that, you know, huge kind of scheme and industry — yes, it makes it a lot more personal. And it does make me so much more passionate about actually getting this done this session," Harris said. 

The bill is modeled after a similar Senate measure that didn't pass last session but has been re-filed this session as a companion to Rep. Harris' bill. 

"It's just rational transparency for everyone to have in paying for medical services, regardless of where or which — which doctor or outlet you're getting it from," said Sen. Paul Bettencourt, R-Houston. "This bill should have wide bipartisan support. It should have a lot of common sense, you know, recognition, and I think that it's got a very good chance of passing this legislative session."

He's the co-author of Senate Bill 490, filed by Sen. Bryan Hughes, R-Mineola, who was unavailable for comment.

The bill also states that the appropriate licensing authority may take disciplinary action against a health care provider that's in violation. 

"If you put out a bill and people refuse to do it, that means they're either unable or unwilling. OK, well, unable — they need to get it fixed. If it's a hospital billing issue, they should get it fixed. If they're just unable, for some reason, you have to have a hammer that says, look, this is the law and don't violate it," he said. 

Costs concerns 

Texas 2036, a non-profit public policy organization, followed the bill closely last time testifying in support of it and will do so this session.

"We know that in many cases, not all, but in many cases, there are errors in those bills. And the only way that people really have an opportunity to check their bill to make sure that it's accurate is if they are able to receive an itemized bill," ​said ​Charles Miller, senior policy advisor with the organization. "We think it's a pretty small ask that before you go ahead and collect money from an individual, that you provide them with an itemized list of what it is that they're being charged for."

The Texas Hospital Association has concerns, including that providing itemized invoices for every patient's bill would be costly and time-consuming. 

"Similar to last session, THA opposes this legislation and is working with the bill authors to strike a middle ground that works best for patients. Hospitals support transparency and keeping health care costs down for everyone," a spokesperson said. 

THA added hospitals are already required to notify patients of their right to request an itemized statement and to produce them if requested.

"Itemized bills are not particularly useful or informative for patients because most charges are paid in a bundle. Also, the bills can be granular, lengthy and costly to produce," the spokesperson said. 

Harris, who was a staffer last year with Sen. Hughes' office, worked closely on the bill. She recalled the pushback and hopes the groundwork on the bill last session will make a difference this time around. 

"The things I heard almost were a little insulting to me. One thing I heard was that consumers don't want this, or — and that — that they wouldn't even understand it if they got it. And you know, that to me, it just goes back to the industry itself and how it's more weighted towards providers and not as weighted towards consumers. And so, this bill is just an attempt to move that weight and give the power to consumers to make those decisions," she added. 

The "Medical Debt Lawsuit" project launched on Sept. 12, 2022, produced by Catalyst – a specialty unit within the KXAN investigative team focused on “digital-first” storytelling that aims to make a positive change in society. The unit takes a multi-platform, innovative approach to each project and rotates among various investigators. Senior Investigative Producer and Reporter David Barer, Investigative Photojournalist Richie Bowes, Graphic Artist Aileen Hernandez, Digital Special Projects Developer Robert Sims and Digital Director Kate Winkle contributed to this update.