Texas Patients Shouldn’t Pay the Price for Freestanding ER Price Gouging

Texas lawmakers must protect patients by reining in excessive freestanding emergency rooms (ERs) costs.

Freestanding ERs are physically separate from a main hospital campus. They.can look a lot like neighborhood urgent care clinics. But the bills they generate can be dramatically different. For example:

• A patient in San Antonio who went to a neighborhood freestanding facility for a tetanus shot received a bill for more than $1,800.

• Another freestanding Houston-based ER  charged patients between $2,000 and $5,000 for Covid-19 tests.

Cases in San Antonio are particularly alarming and out of control.

The city is approximately $40 million over budget on employee healthcare costs this year, and city officials say costly out-of-network freestanding ER care is one of the major contributors.

According to the San Antonio Express-News, one freestanding ER operator accounted for 53% of all emergency room claims among city employees and their dependents in 2025.

Strikingly, the city's average cost per visit to those facilities reportedly jumped from $886 to $1,846, more than doubling.

Those costs aren't all absorbed by an insurance company because it's a cost deriving from city employee care. Therefore, costs are passed along to taxpayers who are already being squeezed by increasing property taxes and more. 

The only fix is a legislative one and there is an opportunity in the coming year to make the change. 

Texas families are already struggling with healthcare costs. They shouldn't also have to subsidize a business model that can turn relatively routine care into an extraordinarily expensive claim.