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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, supplies, or emergency care on or after January 1, 2018.

We can help you with your surprise bill if:

  • You have health coverage through:
    • an insured preferred provider benefit organization (PPO),
    • the Employees Retirement System of Texas, or
    • the Teacher 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:
    • Emergency care by a doctor, hospital, clinic, or other health care provider that isn’t in your health plan’s network, or
    • Medical services or supplies:
      • By a facility-based doctor or other health care provider who isn’t part of your health plan’s network.
      • And at one of the following places in your health plan’s network:
        • Hospital,
        • Ambulatory surgical center,
        • Birthing center, or
        • Freestanding emergency medical care facility.

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: 1/31/2018