Texas Billing Rights

Additional State-Law Protections for Patients with State-Regulated Health Plans

• The Texas law protects certain covered patients from surprise medical bills in emergencies, when they didn’t have a choice of doctors, or when they receive emergency ground ambulance services. The law bans doctors and providers from sending surprise medical bills to patients in those cases. It does not apply to air ambulance services.
  • State law authorizes arbitration (for doctors) and mediation (for facilities) to resolve payment disputes in those cases.
  • The law carves out a narrow exception when a consumer chooses an out-of-network doctor or provider at an in-network facility. See the Balance billing waiver at www.tdi.texas.gov/medical-billing/providers.html#waiver.
• Texas’s surprise billing laws apply to state-regulated health insurance regulated by the Texas Department of Insurance. How can you tell if a plan is regulated by TDI?
  • The patient’s insurance card will have TDI or DOI on it. See examples at www.tdi.texas.gov/consumer/insurance-card-examples.html.
  • The patient is insured through the Employees Retirement System of Texas (ERS): HealthSelect at ers.texas.gov/active-employees/health-benefits and other ERS plans at ers.texas.gov/Active-Employees/Health-Benefits/HMOs.
  • The patient is insured through the Teacher Retirement System of Texas (TRS): TRS ActiveCare at www.trs.texas.gov/Pages/healthcare_trs_activecare.aspx and TRS-Care Standard for non-Medicare retirees at www.trs.texas.gov/Pages/healthcare_trs_care.aspx.
• Texas law also permits self-insured and self-funded plans to elect to participate in Texas’ state-level surprise billing law.

Additional State Guidance

If you have questions about your bill, call the doctor or provider who billed you. If they have questions, they should call your health plan.

Filing a Complaint

• If you want to file a complaint about a doctor: Go to the Texas Medical Board website at www.tmb.state.tx.us/page/place-a-complaint. You also can use the Texas Medical Board website to file a complaint about physician assistants, acupuncturists, surgical assistants, respiratory care practitioners, medical radiologic technologists, medical physicist, and perfusionists.
• If you want to file a complaint about a hospital or facility: Contact Texas Health and Human Services at www.hhs.texas.gov/about/contact-us.
• If you want to file a complaint about your health plan or insurance company: Go to the Texas Department of Insurance’s “Get help with an insurance complaint” webpage at www.tdi.texas.gov/consumer/get-help-with-an-insurance-complaint.html.

State Agency Contact Information

Texas Department of Insurance

Phone: 800-252-3439
Website: www.tdi.texas.gov/medical-billing/smbm-20.html

Additional Information

Visit www.cms.gov/nosurprises/consumers or call 800-985-3059 for more information about your rights under federal law.