A Vote for Texas Patients: Access to ER Care and Coverage for Legitimate ER Visits Protected by the Texas House

House Bill 1832 Passes 113-35, Moves to the Texas Senate

Austin, TX - May 8, 2019 –The Texas Association of Freestanding Emergency Centers (TAFEC) commends the passage of HB 1832 by a strong majority, as it would prohibit health insurance companies that operate in Texas from violating the Prudent Layperson Standard. Most often, insurers do this by implementing policies or practices that render coverage for emergency services dependent upon a final diagnosis. This is already against the law; HB 1832 would ensure that there are strong penalties against violators of this vital patient protection law.

This means that instead of a retroactive denial of medical coverage from an insurance company, based on its review of a patient record, the claim will be based on the symptoms that caused the patient to seek emergency care. This will enforce existing federal and state laws that protect patients who genuinely think they are having a medical emergency. For instance, if a patient is having chest pains, they fear is a heart attack, but it turns out to be acid reflux, he or she will not have to unnecessarily shoulder the entire cost of an emergency room visit.

Great credit is owed to the House authors of HB 1832: Reps. Julie Johnson (D-HD-115), Tom Oliverson (R, HD-130), Stan Lambert (R-HD-71) and the bill’s multiple co-authors. Next, the Prudent Layperson Standard defense companion effort, SB 1282 by Sens. Donna Campbell (R-SD-25) and Dawn Buckingham (R-SD-24) will be up for consideration in the Senate. TAFEC is working closely with physicians and patient advocates in the Texas Legislature to protect Texans’ ready access to life-saving emergency care and to reinforce the Prudent Layperson Standard, enshrined in both state and federal law and enforced in 47 states.

The Prudent Layperson Standard, adopted through Texas Senate Bill 385 in 1997, states if a patient believes he or she is having a medical emergency that requires a trip to the ER, their health insurer is required by law to cover the visit. However, since last August, the largest health insurer in Texas has been permitted by the Texas Department of Insurance to determine whether or not an ER visit is emergent based on a patient’s final diagnosis, as opposed to the patient’s presenting symptoms.

This practice is a dangerous attempt to strip away from patients the power to determine what constitutes a medical emergency—and thus forces the average person to make a best guess about whether their condition is life-threatening or not. Studies in the Journal of the American Medical Association show a 90 percent overlap in the symptoms experienced by patients with life-threatening medical emergencies and those who ultimately have less serious conditions.

When medical emergencies occur, unobstructed and convenient access to high-quality emergency care is the top priority. That’s not a privilege; it’s a basic healthcare right. Yet, Texas ranks 47th nationwide for access to emergency care and the state previously received an ‘F’ for this dismal distinction from the American College of Emergency Physicians.

HB 1832 and SB 1282 will prohibit health plans from implementing any practice that renders coverage for emergency services dependent upon a final diagnosis. Whether or not a symptom, physical complaint, or injury results in a true medical emergency, the ER visit must be covered by insurance. A failure to comply with this regulation will be considered an unfair or deceptive act or practice in the business of insurance. This legislation protects patients from insurance companies’ profit-driven manipulations.

Texans’ healthcare rights demand strong protections—HB 1832 and SB 1282 will do much to ensure those protections.



The Texas Association of Freestanding Emergency Centers (TAFEC) is a member-based association representing freestanding emergency centers in Texas. The Association works with state leaders to ensure the fair regulation and growth of this industry, as well as raising public awareness of the industry and promoting an overall understanding of the unique benefits of freestanding emergency centers.

The patient advocacy arm of TAFEC is My Emergency + My Choice. This site serves as a resource for patients statewide. Visit today and learn more about TAFEC’s patient-centered legislative agenda.

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