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How to avoid a surprise medical bill

Balance billing – or a surprise medical bill – happens when you get a bill from a doctor, hospital, or other health care provider who isn’t part of your health plan’s network. Here are some tips to help you avoid surprise bills.

1  Know your network

Check what hospitals and emergency rooms in your area are in your health plan’s network – before you’re in the middle of an emergency.

Select specialists in your plan’s network. For planned procedures, such as a surgery, check to make sure the hospital or facility is in network. Ask what other providers might bill for services and if they are in your plan’s network. This could include radiologists, anesthesiologists, labs, pathologists, assistant surgeons, and neonatologists.

2  Check your coverage

Call your health plan to make sure the services you will get are covered under your policy. Ask if any approval is needed before you get the service. Make sure you have current referrals for specialists if required by your plan.

3  Get an estimate

Texas law gives patients the right to request estimates of charges. Doctors and other providers and health plans have 10 days to give you the estimates, so you won't be able to get them in cases of emergencies. Some providers and health plans also have cost information on their websites.

4  Compare prices

Check websites that can help you estimate the prices of procedures:

5  Work with your plan

If you can’t find a provider in network, call your health plan. If the doctor or provider of your choice isn’t in network, your health plan might be able to work out a lower price for the service. In some cases, the health plan may be required to make sure you aren’t balance billed.

Did you get a surprise bill?

If your health plan is regulated by the state, TDI may be able to help. Call our Consumer Help Line at 1-800-252-3439 to discuss your options. There are two main ways TDI can help:

  1. Mediation: Texas law allows many consumers to seek mediation for some bills.
  2. Complaints: Each year, we help thousands of Texans get millions of dollars in additional claim payments and refunds.


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Last updated: 7/5/2018