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How to get help with a surprise bill you got from a health care provider

Mediation for a health insurance claim

Read these instructions and fill out the form that is linked below if you got medical services or supplies before January 1, 2018.

We can help you with your surprise bill if:

  • You have health coverage through an insured preferred provider organization (PPO) or the Employees Retirement System of Texas.
  • The amount of the bill is more than $500, not including copays, deductibles, and coinsurance.
  • You didn’t sign an estimate that shows a cost of services that is the same or less than your bill.
  • You were billed for medical services or supplies:
    • At a hospital that is in your health plan’s network, and
    • By one of the following hospital-based providers who isn’t in your health plan’s network:
      • Radiologist
      • Anesthesiologist
      • Pathologist
      • Emergency department physician
      • Neonatologist
      • Assistant surgeon

If you meet the above rules:

Fill out the form, Get help with a surprise bill you got from a health care provider.

Learn more about how this process works:

Visit our How Mediation Works web page. 

If you aren’t able to get help with a surprise bill:

You can file a complaint about your health insurance. To learn more, go to our Insurance Complaint Process web page.



For more information, contact:

Last updated: 12/05/2017

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