Federal Surprise Billing Act of 2022
Your Rights and Protections against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn't be charged more than your plan's copayments, coinsurance and/or deductible. See additional FAQs further down this page.
What is “balance billing” (sometimes called “surprise billing”)?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.
“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan's deductible or annual out-of-pocket limit.
“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider. Some surprise medical bills could cost thousands of dollars depending on the procedure.
You are protected from balance billing for:
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.
Texas law protects patients with state-regulated health insurance (about 16 percent of Texans) from surprise medical bills in emergencies or when they didn’t have a choice of doctors. The law bans doctors and providers from sending surprise medical bills to patients in those cases.
Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.
If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.
Texas law also prohibits balance billing for any health care, medical service or supply provided at an in-network facility by an out-of-network physician or other provider and for services by diagnostic imaging providers and laboratory service providers provided in connection with a health care service performed by a network physician or provider.
You’re never required to give up your protections from balance billing. You also aren’t required to get out-of-network care. You can choose a provider or facility in your plan’s network.
When balance billing isn’t allowed, you also have the following protections:
- You're only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
- Generally, your health plan must:
- Cover emergency services without requiring you to get approval for services in advance (also known as “prior authorization”).
- Cover emergency services by out-of-network providers.
- Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
- Count any amount you pay for emergency services or out-of-network services toward your in-network deductible and out-of-pocket limit.
If you think you’ve been wrongly billed, contact the Centers for Medicare and Medicaid Services at 1-800-985-3059 or the Texas Department of Insurance at (800) 252-3439.
Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.
Visit https://www.tdi.texas.gov/medical-billing/surprise-balance-billing.html for more information about your rights under Texas law.
You have the right to receive a “Good Faith Estimate” explaining how much your health care will cost
Under the law, health care providers need to give patients who don’t have certain types of health care coverage or who are not using certain types of health care coverage an estimate of their bill for health care items and services before those items or services are provided.
- You have the right to receive a Good Faith Estimate for the total expected cost of any health care items or services upon request or when scheduling such items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- If you schedule a health care item or service at least 3 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 1 business day after scheduling. If you schedule a health care item or service at least 10 business days in advance, make sure your health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after scheduling. You can also ask any health care provider or facility for a Good Faith Estimate before you schedule an item or service. If you do, make sure the health care provider or facility gives you a Good Faith Estimate in writing within 3 business days after you ask.
- If you receive a bill that is at least $400 more for any provider or facility than your Good Faith Estimate from that provider or facility, you can dispute the bill.
We will verify your coverage and obtain your benefits to determine any amounts you may owe before your service. We also do this whether you have coverage or not. We will provide an estimate of your costs and any amount you may owe based on what your doctor has ordered and schedules. This including deductibles, co-payments, and co-insurance.
We will contact you before your service date to review your estimated amount due, collect your deposit and/or make other arrangements with you.
You will be billed once your payor has processed your claim or once the amount due by you is known. What you owe may be higher or lower than the estimate. If the estimate is more than the actual amount due, we will process the credit.
Payment by Insurance or Other Coverage
If you have insurance or other coverage, we will bill your insurance company or other coverage shortly after your visit and then send you notification of the charges submitted. This statement is for informational purposes only. You should also receive an explanation of benefits (EOB) from your insurance company or other coverage explaining how it processed your claim and the amount due by you. This process is usually complete within 60 days of discharge.
Your insurance company or other coverage may contact you for additional information to process your claim. Please respond as quickly as possible to ensure you receive the maximum benefit from your coverage. If you do not respond to this request for information, your claim may be denied and you will be billed.
After the insurance or other coverage payment has been received, you will receive a final billing statement from Texas Health Resources for the remaining balance, which may include deductibles, co-insurance, co-payments and any non-covered charges. If you have questions regarding the way your claim was processed, please contact your insurance company or other coverage directly.
Payment is due upon receipt of the final billing statement. You may manage your account balance on MyChart. Please see your final billing statement for online resources, or you may contact Customer Service at 800-890-6034 from 7 a.m. to 6:30 p.m., Monday through Friday, to discuss payment options with a representative.
For patients with insurance or other coverage, Texas Health hospitals will not routinely reduce or waive patients’ co-payments, co-insurance or deductibles and will make reasonable efforts to collect payment for non–covered services. Patients who have insurance or other coverage, but choose to not utilize for a scheduled service, may be offered a discount. For more information Call 877-773-2368, Option 3, Monday through Friday, 8 a.m. to 6 p.m.
Payment without Insurance or Other Coverage
Our hospitals offer a discount for patients without insurance or other coverage. The discount is equal to 40 percent of the estimated total charges for anticipated hospital charges. It is automatically applied at the time of billing to all accounts designated as "self-pay." After the discount is applied, you will receive a statement notice on MyChart. You may also manage your account balance on MyChart. If payment in full is not possible, we will work with you to set up a payment plan, obtain coverage through Medicaid or apply for Financial Assistance.
The Texas Health uninsured discount applies only to hospital charges. Charges for physicians and other professional services that are provided while a patient is hospitalized, or charges by other providers for non-hospital services, are not covered by the Texas Health discount policy.
What are my options if Texas Health does not accept my insurance or other coverage?
If your insurance plan is not listed here, your insurance or other coverage may be out of network with Texas Health. If you wish to receive services at Texas Health as an out of network hospital, then a single case agreement (SCA) may be required. An SCA is an agreement between Texas Health and a non-contracted insurance or other coverage plan. A patient can request an SCA directly from their insurance or other coverage plan if they want to receive services at Texas Health. The insurance or other coverage plan would work directly with Texas Health to complete the SCA, which outlines authorization and payment terms, prior to services performed.
If your insurance or other coverage will not complete an SCA with Texas Health, or if you have insurance or other coverage and choose to not use it, you may still receive services at Texas Health as long as payment in full is made prior to services being rendered. Texas Health also offers discounts to patients who do not have any coverage. For more information, please contact our office at 877-773-2368, Option 3, Monday through Friday, 8 a.m. to 6 p.m.
Your hospital bill contains charges for hospital services only. Certain professional and physician services are often performed along with hospital services as ordered by your various treating physicians. You will be billed separately for other services such as:
- Physicians, other health care providers or other professional fees or charges
- Emergency room physicians
- Radiologists (Examples: physicians who interpret X-rays, MRI, CT, ultrasound)
- Pathologists (Examples: physicians who examine body tissues and body fluids reads)
- Cardiologists (Examples: physicians who treat heart and blood vessel conditions)
- Neonatologists (Examples: physicians who treat newborns in the neonatal intensive care unit)
- Anesthesiologists (Examples: physicians who administer general/regional anesthesia and pain management)
- Other consulting physicians
These providers are independent from the hospital and bill separately for their services.
Texas Health Resources cannot ensure physicians are contracted providers with your insurance company or other coverage provider network. Questions about these bills should be directed to the physician office listed on the billing statement for those services.
Online Bill Payment
If you have a balance after discharge, you may pay your bill on MyChart with an e-check, debit or credit card. This is an easy, secure and free way to submit payment. MyChart allows you to manage your account online. You can also “Pay as Guest” if you don’t have a MyChart account. You will need your account number and guarantor information.
Payment can also be made over the phone by calling our customer service department at 800-890-6034 from 7 a.m. to 6:30 p.m., Monday through Friday. Your account number will also be requested for this transaction.
We are pleased to assist you in any way should you need to contact our customer service team. Our team can be reached at 800-890-6034 from 7:00 a.m. to 6:30 p.m., Monday through Friday, or you may email CustomerService@TexasHealth.org. Please have your account number available for our team to assist you.
Our Customer Service team is happy to assist with any of the following billing services:
- Pay Your Bill
- Discuss Payment Options
- Request an Itemized Bill
- Address Insurance or Other Coverage Questions
- Request Financial Assistance
Texas Health also offers online/self-service for these billing services on TexasHealth.org/MyChart in addition to an automated phone service that is available 24 hours a day, seven days a week.
Annual Report of Community Benefits
Each year Texas Health Resources files a Community Benefits Plan with the Texas Department of Health, Bureau of State Health Data and Policy. The Community Benefits Plan is public information as of the date it is filed with the Texas Department of Health and is available from the Department on request at the address below.
Texas Department of Health
Bureau of State Health Data and Policy Analysis
1110 West 49th Street
Austin, Texas 78756
Are itemized statements automatically sent to patients?
Texas Health will add an Itemized Bill, per SB 490 to your MyChart account at the time of billing. You may also request an itemized statement at any time post billing by calling the business office at 800-890-6034 from 7:30 a.m. to 6:30 p.m., Monday through Friday, or you may email CustomerService@TexasHealth.org.
Can I make an appointment to talk to someone in person about my bill?
I could not find my question on this list. How do I get answers?
What are my payment options?
What health plans are honored at Texas Health hospitals?
Texas Health contracts with many health plans. Follow this link for a complete listing of accepted insurance carriers. The information on this list is subject to change at any time and without notice. Please contact your health plan to confirm a facility's continued participation in your particular network.
What if there is an error on my bill?
If you have questions about your bill, or believe that it is incorrect, call the business office at 800-890-6034 from 7 a.m. to 6:30 p.m., Monday through Friday, or email CustomerService@TexasHealth.org.
What is a co-payment?
A co-payment is a set fee the member pays to providers at the time services are provided. Co-pays are applied to emergency room visits, hospital admissions, office visits, etc. The cost is usually minimal. The patient should be aware of the co-payment amounts prior to services being rendered.
What is a deductible?
Deductibles are provisions that require the patient to accumulate a specific amount of medical bills before benefits are provided. For example, if a patient’s policy contains a $500 deductible, the patient must accumulate and pay $500 out of pocket before the insurance or other coverage plan will pay benefits. Once the patient has met their deductible, the insurance or other coverage plan usually pays a percentage of the bill. The patient is liable for the unpaid percentage. Deductibles are yearly, usually starting in January. Contact your insurance or other coverage plan for information about your deductible.
What is co-insurance?
Co-insurance is a form of cost sharing. After your deductible has been met, the plan will begin paying a percentage of your bills. The remaining amount, known as co-insurance, is the portion due by the patient.
Why did my insurance only pay part of my bill
Most insurance or other coverage plans require you to pay a deductible, coinsurance and/or copayment. If you have any coverage or benefit questions, please contact your insurance company or payer.
Why do I get so many bills for my hospital visit
Emergency room doctors, anesthesiologists, radiologists, primary care physicians and other providers are all independent providers. They bill separately from the hospital. Questions about these bills should be directed to the physician office or provider listed on the billing statement for these services.
Why do I need to call the insurance company if they do not pay the bill?
The Central Billing Office will make every effort to resolve the account balance with your insurance carrier or other coverage. Occasionally, we will be unable to resolve the issue with your carrier or other coverage and will need your assistance.
Will my insurance plan pay for my treatment?
You need to begin by verifying that your insurance plan or other coverage is honored at the facility where you are being treated. Each insurance plan or other coverage is different, and even within the same company one insurance plan or other coverage may cover a certain treatment while another does not. Furthermore, participation in a plan by a Texas Health Resources facility does not guarantee that it is approved for all services. Contact your specific insurance plan or other coverage to verify whether your treatment will be covered and what your benefits for your treatment are.
What do I do if I need assistance paying my bill?
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Contact Customer Support
We are pleased to answer your questions or provide additional information. Our customer service representatives can be reached at 1-800-890-6034 from 7 a.m. to 6:30 p.m., Monday through Friday.
A representative will request your account number and be available to answer any questions about your account and/or bill.
Customer service representatives are happy to assist with the following billing services:
- Pay Your Bill
- Discuss Payment Options
- Request an Itemized Bill
- Address Insurance or Other Coverage Questions
- Request Financial Assistance
The representative will request your account number.