Your Rights and Protections against Surprise Medical Bills

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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:

Emergency services
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.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises/consumers, email FederalPPDRQuestions@cms.hhs.gov, or call 1-800-985-3059.

We will attempt to determine any amount you may owe prior to your service. For patients with coverage, we will include verification of coverage and benefits. We will provide an estimate of your costs and any amount you may owe based on what your doctor has ordered and schedules. Your amount due may include co-payments, deductibles, co-insurance or non-covered amount.

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.

Texas Health will bill insurance companies that we are in network with, shortly after your visit and then send you notification of the charges submitted. This notice is for informational purposes only. We may bill insurance companies or other coverage that we are not in network with on a case by case basis. 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. For more information regarding pre-service collection practices, call 877-773-2368, Option 3, Monday through Friday, 8 a.m. to 6 p.m.

Texas Health offers discounts for patients without insurance or other coverage. The discount for hospitals is equal to 40 percent of the total charges. The discount for physicians/providers is equal to 50 percent of qualifying 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, you may create a payment plan or apply for Financial Assistance (Hospital balances only) through MyChart, or you may contact us to assist you further.

Texas Health uninsured discounts apply to Texas Health hospitals and physicians/providers only. Charges for non Texas Health physicians/providers for services provided to patients while a patient is hospitalized, or charges by other providers for non-hospital services, are not covered by Texas Health.

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 Texas Health bill may contain balances due for Hospitals, THPG Physician Providers, Texas Health Breeze Urgent Care or Texas Health Virtual Behavioral Health services. 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 that are not THPG physician providers
• 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

Non THPG physicians/providers are independent from Texas Health 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.

If you have a balance after after services are provided, 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.

Billing services may be completed via MyChart Billing, 24/7. However, if you wish to speak with us, our team can be reached Monday through Friday 7:00 a.m. to 6:30 p.m. via:

• MyChart Billing Message
• Contact Us Form
• Telephone at 800-890-6034
• Email CustomerService@TexasHealth.org

MyChart, or the Customer Service team is able to complete any of these billing services:

• Pay your bills
• Create payment plans
• Obtain itemized charges
• Validate or modify insurance or other coverage
• Financial assistance

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

Itemized Statements (informational only) AND Itemized Bills, per SB490 will be added to MyChart at the time of billing. If you have opted out of MyChart Billing, you will receive an SB490 Itemized Bill when there is a patient due balance. You may also request an itemized statement at any time post billing by messaging customer service via MyChart Billing Message, Contact Us Form, Calling us at 800-890-6034 or emailing CustomerService@TexasHealth.org. Our business hours are 7 a.m. to 6:30 p.m., Monday through Friday.

Yes. You can schedule an appointment by messaging customer service via MyChart Billing Message, emailing CustomerService@TexasHealth.org or calling us at 800-890-6034. Our business hours are 7 a.m. to 6:30 p.m., Monday through Friday.

You may contact us by messaging customer service via MyChart Billing Message, emailing CustomerService@TexasHealth.org or calling us at 800-890-6034. Our business hours are 7 a.m. to 6:30p.m., Monday through Friday.

You may pay via MyChart or by phone 24/7. Or you may speak to an agent during our business hours from 7 a.m. to 6:30 p.m., Monday through Friday, by calling 800-890-6034.

Payment methods accepted: Check, ACH, Credit Card, Debit Card, HSA, FSA, Google Pay and Apple Pay

Texas Health does not currently accept Care Credit.

Note: Not all payment methods accepted in every application.

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.

If you have questions regarding your bill, you may contact us by messaging customer service via MyChart Billing Message, Contact Us Form, Calling us at 800-890-6034 or emailing CustomerService@TexasHealth.org. Our business hours are 7 a.m. to 6:30 p.m., Monday through Friday.

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.

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.

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.

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.

Emergency room doctors, anesthesiologists, radiologists, primary care physicians and other providers are all independent providers. Non THPG Physician/Providers will 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. Your Texas Health bill will include THPG Physicians/Providers involved in your hospital care. Contact us by messaging customer service via MyChart Billing Message, Contact Us Form, Calling us at 800-890-6034 or emailing CustomerService@TexasHealth.org. Our business hours are 7 a.m. to 6:30 p.m., Monday through Friday.

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.

You need to begin by verifying that your insurance plan or other coverage is honored at the entity where you are being treated. Each insurance plan or other coverage is different, even within the same insurance company. Coverage is dependent on what you or your employer has purchased and deems covered. Furthermore, participation in a plan by a Texas Health Resources entity 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.

If payment in full is not possible, Texas Health has options.