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How Mediation Works

Within 30 days of your request for mediation, the parties must participate in an informal telephone conference. The carrier will tell you when this will occur. You may request that additional claims involving the same physician and carrier be mediated, but the other parties are not required to agree.

The actual mediation conference will be held within 180 days of your request for mediation. You have a right to a mediator appointed by the State Office of Administrative Hearings, or the parties may unanimously agree to use a different mediator. The carrier and the physician will each pay one half of the mediator's fees.

You are not required to attend the actual mediation, which must be held in the county where the services were provided. Your physician and your carrier will discuss resolution regardless of whether you attend. You may also choose to have a representative attend with you or in your place.

If you choose to attend, you will have an opportunity to state your position. A mediation may not last more than four hours unless the provider and carrier agree to mediate for longer.

The parties are not required to reach an agreement at mediation but, if no agreement is reached, the matter may be referred to a special judge for resolution. Requesting mediation does not limit your ability to take the matter to court.

Mediating a claim does not mean that you are no longer responsible for any payments. Instead, the goal of the mediation is to reach an agreement between you, your physician, and the carrier as to the amount charged by the physician, the amount paid by the carrier to the physician, and the amount paid by you to the physician.

Once your physician has received notice that you have requested mediation, your physician may not attempt to collect any payment (other than for copayments, deductibles, and coinsurance) until the mediation ends or the request to mediate is withdrawn.

Additional Resources

Publications

File an Insurance Complaint

Read about TDI's consumer complaints process in the Helping You With Your Insurance Complaint publication. You may also e-mail, mail, or fax your complaint along with copies of your supporting documents to

Texas Department of Insurance
Consumer Protection Program (MC 111-1A)
P.O. Box 149091
Austin, TX 78714-9091
Fax: 512-490-1007
Email: ConsumerProtection@tdi.texas.gov

Prevent Insurance Fraud

Report fraud online or by calling 1-888-327-8818

Get Help from TDI

For insurance questions or for help with an insurance-related complaint, call the Consumer Help Lineat 1-800-252-343between 8 a.m. and 5 p.m., Central time, Monday-Friday, or visit our website.



For more information, contact:

Last updated: 12/04/2017

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