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Texas ruling on $11,000 ER bill may have long-lasting effects, experts say | Dallas News

“We don’t want courts determining what is usual and customary. We prefer they stay out of pricing, as a general rule,” she said.

Six of the nine justices signed the opinion. The final three issued a dissenting opinion, siding with the hospital. The dissent argued that neither the court nor the plaintiff could state how confidential reimbursement rates could be used to show that charges to an uninsured, self-paying consumer are unreasonable.

The debate is one that’s drawing attention not just in Texas — where both traditional hospitals and freestanding emergency rooms have been in public wars over negotiated rates — but on a national scale.

Health care price transparency has emerged as a hot topic among state legislatures, consumer groups and the federal government as the nation scrambles to contain unwieldy health costs.

There are many approaches that have varying level of success. Since 2005, California has required hospitals to publicly list the average charges for common outpatient procedures.

A handful of major health insurance companies have partnered to voluntarily share data anonymously about what they pay, which has led to regional comparisons. But it’s mainly  a research tool, said Dr. David Blumenthal, president of the Commonwealth Fund, a private group based in New York that researches ways to make the health care system more efficient.

“It’s helpful from a policymaking standpoint, but not a consumer standpoint,” he said.

And getting hands on data can be tricky, even for policymakers.

For example, pharmaceutical giant Pfizer sued the state of Texas in 2016 because the Texas Health and Human Services Commission provided two state lawmakers — who were trying to draft budgets– details about Pfizer’s negotiated drug pricing rates in the Texas Medicaid program, the most expensive health care program administered by the state.

The courts have been where more of these cases have been bubbling up. However the movement toward health care price transparency got a  major boost last week, when the Centers for Medicare & Medicaid Services issued a more than 1,800 page proposal that, among other issues, expressed concern about surprise medical bills and other cost-related issues.

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Texas ruling on $11,000 ER bill may have long-lasting effects, experts say | Health Care | Dallas News.